WHAT HEART PATIENTS 
SHOULD KNOW AND DO 



JHHONAN MD 




Copyright N^ 



COPYRIGHT DEPOSIT. 



What Heart Patients Should Know and Do 



What Heart Patients Should 
Know and Do 

Suggestions for Persons Suffering from Diseases 

of the Heart and Blood Vessels. Exercise, 

Diet, Prevention, etc. , and Advice as 

to the Regulation of Their Lives 

By 

JAMES HENRY HONAN, M.D. 

Rush Medical College (University of Chicago), M.D.; Imperial Friedrich 
Wilhelm University of Berlin, M.D.; Special Lecturer on Cardio-Vascular 
Disease in the University of Georgia ; Honorary Member of the Amer- 
ican Medical Association ; Honorary President and formerly Active 
President of the Anglo-American Medical Association in Berlin; 
Mitglied des Vereins fiir Innere Medicin. Deutschland; 
Mitglied des Aerzte Verein zu Bad-Nauheim; etc. 




New York 

Dodd, Mead and Company 

1913 



Hi 



Copyright, 1913, by 

DODD, MEAD AND COMPANY 

Published May, 1913 



©CI.A347313 
Ml 



PREFACE 

The object of this little book is to give encourage- 
ment and hope to those persons who know 
that they have heart trouble, to urge those 
who are suspicious of its presence, but who 
fear having their suspicions confirmed or 
who are too strenuously occupied to give much 
consideration to their health, to seek advice 
in time; to ascertain as accurately as possible, 
without undue anxiety, whether the bodily ma- 
chinery is in good condition or what may be done 
in way of repair; to help, if possible, both these 
classes of persons to make the most of their lives 
with limitations which deviation from the normal 
imposes, to warn them to avoid those things which 
every year lead to the needless and tragic sacrifice 
of innumerable valuable lives. 

So many of the world's able men and women 
might still have had years of usefulness, if they 
had only observed their limitations or had not held 
business or social interests of greater moment than 
their health; unwittingly or indifferently causing 
or aggravating affections of the heart and shorten- 
ing the number of their days. 

To urge upon every one, whether ill or well, the 
importance of knowing something about his 



VI PREFACE 

physical body, of knowing what the scientific men 
who devote their lives to the study of the preven- 
tion and cure of disease have to suggest, to use 
such judicious conservatism In the expenditure of 
his strength and health as he is accustomed to 
apply to his resources in financial affairs. 

This book is in no sense to be a substitute for 
the physician, nor a promise of health to all who 
may read its pages. 

Again and again In my experience with pa- 
tients, in noting how many of them harm them- 
selves every day of their lives, in observing 
how much a favourable forecast depends upon 
their comprehending certain causes and effects 
and upon their willingness to co-operate with the 
physician, again and again in my reading and ex- 
perience the importance of the patient's knowing 
more about himself has been impressed on me, and 
I have asked myself, *' Cannot much of the gen- 
eral medical experience and the results of re- 
search, recorded for the guidance of physicians, 
help and lead to a more united and beneficial co- 
operation ? " It is the conviction that it may which 
has led me to write this book, to make In this 
form my contribution to the good cause of mainte- 
nance or restoration of health, to share In the 
effort of the various health organisations of the 
American Medical Association and kindred organ- 
isations in other lands, toward educating the public 



PREFACE vii 

concerning the prevention and cure of disease and 
the conditions favourable to the restoration of 
health and the alleviation of suffering. 

In acknowledging my Indebtedness for many 
valuable hints and suggestions in the preparation 
of this work to the medical writings of Drs. Bab- 
cock, Chicago; Broadbent, London; Hay, Liver- 
pool; His, Berlin; Kraus, Berlin; Krehl, Heidel- 
berg; Lewis, London; Mackenzie, London; O. 
Miiller, Tubingen; Russell, Edinburgh; Osier, 
Oxford; Romberg, Miinchen; Vasquez of Paris, 
and very especially to Dr. Rufus Cole of the 
Rockefeller Institute, New York, who read the 
manuscript, it is with the conviction that all of 
them would ask from me no other recompense 
than that I may perchance help our suffering 
fellow-men. 

That this book may give hope and encour- 
agement to the discouraged, that it may lead to 
the prolongation of lives dear to the family and 
valuable to the community, state and world, is the 
sincere wish of the author. 

J. H. HONAN. 

Bad-Nauheim, 
Germany. 

October i, 1912. 



CONTENTS 

PAGE 

The Forecast i 

Prevention 6 

Relaxation 12 

Clothing 16 

Climate and Environment ... 27 

Exercise 39 

Diet . 59 

Bodily Waste .103 

Baths 105 

Sleep 112 

Habit 118 

The Heart AND Circulation . . .124 

Blood Pressure 133 

Arterio-Sclerosis, or Hardening of 

the Arteries 137 

Obesity 149 

Metabolic Diseases . . . .152 
"Leaky Heart" ; . . . . 153 

Weak Heart 160 

Angina Pectoris . . . . .166 

Nervous Heart 175 

Rheumatism .182 

General Advice 185 

ix 



What Heart Patients Should Know and Do 



THE FORECAST 

Hope stands on the threshold to give an honest 
word of cheer and encouragement to those who 
are suffering from heart trouble, many of whom 
are filled with exaggerated apprehension and fear. 
*' Knowledge never dispelled the terrors of dark- 
ness with more effect than in showing the 
true meaning of the symptoms in affections 
of the heart/' says one of the foremost Eng- 
lish authorities on the heart. It seems sig- 
nificant that a man, bearing the name of 
Hope, no mythical person, but an earnest 
observer and man of science, is the one to 
whom much of the terror-dispelling knowledge 
Is due. It was he who first gave a rational inter- 
pretation to " heart murmurs,'' " heart sounds,'* 
by the term '' heart signs " in place of the fear- 
imparting morbidities with their incorrect deduc- 
tions of the then prevailing medical view. It was 
Dr. Hope who, literally as well as figuratively, 
marks an era in the treatment of heart troubles, 
who gave the impulse to further investigations, 
which continue to this day, converting many of 



2 WHAT HEART PATIENTS 

the heretofore alarming manifestations Into 
blessed warnings and guiding signs. 

An undue sense of terror of heart symptoms 
still prevails In the public mind, partly no doubt 
owing to the too conspicuous place given to heart 
failure In mortality reports, a large per cent of 
the fatalities In these reports being attributed to 
the heart, whereas the causes were something 
quite different, the heart simply becoming Involved 
at the very last. From the followers of Hippoc- 
rates, who In the fifth century B.C. believed that 
the heart was Invulnerable, there was for cen- 
turies an extreme reaction, during which too many 
ills were attributed to that organ. There still 
lingers In the public mind a false meaning for 
manifestations of heart disturbance, such as mur- 
murs, Irregularities, palpitations, high blood pres- 
sure, all or any of which are signs of derange- 
ment not necessarily implying a grave condition, 
but always deserving serious investigation. 

If the progress of heart disease Is to be ar- 
rested. If It be the preventable disease which the 
medical profession now pronounces It to be, men 
should have a better comprehension of heart signs 
and avail themselves of timely warnings, in order 
to arrest the development of existing trouble; they 
should know the causes and precautionary pre- 



SHOULD KNOW AND DO 3 

ventlve measures, that the disease may be fore- 
stalled. They should realise that the most trivial 
troubles are worthy of the gravest attention, and 
that in their understanding of the true value of the 
signs, whether they be the first or repeated warn- 
ings of chronic disease, they would free themselves 
from depressing and harmful fears or from un- 
conscious or foolhardy neglect, and largely affect 
their forecast for the future. 

That a more favourable view of various heart 
diseases may be taken is not without fair basis. 

In the first place, there is no organ In the body 
which has such recuperative power as the heart. 

Secondly, there is no other organ which can do 
so much to remedy its own defects or to make 
compensation for them, adjusting and adapting 
itself to new conditions in a most marvellous way. 

Thirdly, many incurable heart troubles are rep- 
arable — they can be corrected, counteracted, the 
functional or structural heart defects counterbal- 
anced. 

Fourthly, medical science knows more about the 
heart to-day than ever before. Not only are signs 
of weakness and defect more readily discovered 
and estimated, but the means of combating the 
progress of disease are better understood. 

Fifthly, the individual often holds his life in his 



4 WHAT HEART PATIENTS 

own hands — a fair assurance of restoration to 
health depending on his willingness to modify his 
mode of life for a few weeks or a few years, to 
take the rest or treatment advised, to be satisfied 
to walk the full course of life, if running involves 
danger. 

Last, but not least, the individual who has heart 
trouble has good reason for entertaining hope as 
long as there is life. Any one who reviews mod- 
ern medical literature must be impressed with the 
great number of cases whose histories continue for 
twenty-five or thirty years after grave manifesta- 
tions of affections of the heart or arteries, and 
where the records or reports of many years are 
only interrupted by the natural ending of the life 
of the patient or retirement or decease of the 
physician. Since the writings of conservative med- 
ical authorities abound with expressions regard- 
ing extreme cases such as ^' All but miraculous 
recoveries," since the personal experience of the 
physician verifies these statements, he can but con- 
clude that there are no *^ hopeless cases," and that 
in affections of the heart more than in other ills 
It may be well said, " As long as there is life 
there is hope." 

Since the comfort or discomfort of the patient 
and his restoration to complete or partial health 



SHOULD KNOW AND DO 5 

depend largely upon his intelligent attitude re- 
garding his condition and upon the proper regu- 
lation or modification of his mode of life, these 
various subjects are considered in the following 
pages. 

As has been said in the preface, this 
book Is in no sense a substitute for the phy- 
sician. To make It such would mean failure 
of its purpose and harm to those who need con- 
stant and individual medical care. It should be 
borne in mind that general suggestions and con- 
clusions made from averages, however helpful and 
useful to many, apply only to the average person, 
and though they may be valuable supplements to 
individual advice, do not take its place. 



PREVENTION 

There is no sufferer who can invest an ounce of 
prevention with a greater assurance of its yielding 
the proverbial pound of cure, and many times that 
pound, as can he who has heart trouble. More 
and more affections of the heart are being classed 
as preventive diseases. The majority are pre- 
ventable in the very beginning, and might have 
been avoided altogether, which, however, may not 
seem to help the person who already has heart 
disease. One does not need to cry over spilt milk, 
neither does it help matters so far as that par- 
ticular loss is concerned to tell the unfortunate 
one how it might have been avoided. At least 
that is the view the reader may take. The one 
who has had losses, however, need not continue 
to have them; in fact, he is the very one who 
should know that he may prevent them. Medical 
literature abounds with examples of persons who 
in youth or middle age manifested symptoms of 
serious heart trouble, but who, because of the 
proper regulation of their lives, counted the full 
number of years allotted to man, while their robust 

6 



WHAT PATIENTS SHOULD DO 7 

neighbours and friends who daily gambled with 
their lives, lost them, without warning, in the very 
" hey-day " of life. 

Preventive measures may not only give years of 
life, but they may give comfort instead of pain. 
There are few chronic diseases of the human 
family so amenable to treatment, and almost none 
so compatible with a long life of comfort if ra- 
tionally taken care of, as those of the heart. 

Heart diseases may be congenital, in which case 
they may have been unpreventable, as far as the 
Individual, the medical advisers, and perhaps the 
parents are concerned. Prevention for these cases 
must consist in regulation of the life, in respect 
to a certain handicap. Many persons have heredi- 
tary tendencies to rheumatism or to other diseases 
kindred to the heart, which may date back to 
carelessness or ignorance of the laws of health on 
the part of the grandparents or of their medical ad- 
visers. 

The underlying principles to be observed In the 
alleviation of heart troubles are proper bodily 
supplies and proportional waste; activities and 
relaxation, both physical and mental, in due 
relationship; moderation in all things, including 
the application of the general laws of hygiene. 
When, as Is repeatedly the case, I hear persons 



8 WHAT HEART PATIENTS 

state that it is not safe to adopt a child without 
a satisfactory history of the grandmother, I say, 
" Why not begin making a generation of good 
grandmothers?" As it is with moral character, 
so is it with physical vigour or resistance to dis- 
ease. Every measure for the preservation of 
health, for the prevention of disease, for the pre- 
vention of the advance of a defective or damaged 
condition, is just so much in favour of the men 
and women of this generation, of the grand- 
parents of the future. Not to be misun- 
derstood, let me say that the term " heredity," 
so far as definite diseases are concerned, is 
dropping more and more into the background, 
the majority of diseases being traced to bac- 
teria or direct exposure. There is, however, 
no doubt in my mind that the health of the par- 
ents, the grandparents and the great-grandparents 
has much to do with the amount of the resistance 
to disease with which the individual comes into 
the world. The mode of life of the child, of the 
youth and the adult may be such, however, as to 
increase or decrease the inherited resistance. 

It is a selfish generation which concerns itself 
only with the present. It was in the so-called 
" Dark Ages " that the magnificent buildings of 
Europe, the great cathedrals were planned, begun 



SHOULD KNOW AND DO 9 

and laboured upon through the best years of one 
generation, continued through the whole lifetime 
of the second generation, to be completed and en- 
joyed In the third or fourth following. The 
people planned and laboured and buUded for the 
men of the future. They were ignorant of many 
things which we know, among them the causes and 
treatment of various diseases, of quick communica- 
tion and of rapid travel, of so-called labour-saving 
machines, many of which simply shift the labour 
from the muscles of men to their nerves; of the 
modern business and commercial methods, with 
the tremendous strain, worry and anxiety; but If 
those of the past could but wake up and behold 
for a day the men of this generation and their 
doings, they might be as much astonished and 
shocked at Irrational use or abuse of present-day 
knowledge and experience as at the wonder of the 
things of which the modern age boasts. How 
may this generation be looked upon by the future, 
this generation with Its rush and exertion, its 
strain, Its waste of nervous energy and life? With 
some perspective and an unbiassed view, the all- 
wise men of this age might seem very like the 
" three wise men of Gotham who went to sea in 
a bowl." This may seem to the reader to have 
nothing to do with the subject In hand, but it is 



lo WHAT HEART PATIENTS 

very much to the point and a serious theme to the 
specialist, who sees the nervous breakdowns, the 
exhausted hearts, the injured blood vessels, di- 
rectly or indirectly due to modern business or 
social conditions, or to the lack of appreciation 
of the value of health in relation to other things 
and the absence of realisation of the importance 
of the prevention of disease. 

Sir James Barr once said: '' I like to get ahead, 
and when possible treat the patient before the 
disease arrives. This, fortunately, is often pos- 
sible in the cases of diseases of the heart." 

First, there are the congenital heart defects, 
preventive measures for which must be directed 
toward arresting the further development of the 
disease. Second, the great number of heart dis- 
eases which afflict persons in early life, the unpre- 
vented preventable sequences of some such acute 
unprevented preventable diseases as rheumatism, 
pneumonia, scarlet fever and diphtheria. The 
lack of prevention of the infectious disease may 
be traceable more to carelessness on the part of 
the community or the lack of efficient health laws 
than to the family or individual afflicted. 

Chronic heart disease being present, serious 
thought should be given to the mode of 
life, to exercise, clothing, food, etc., all of which 



SHOULD KNOW AND DO ii 

are potent in preventing or furthering the 
progress of disease. Any one, whether child or 
adult, who has an infectious disease, the poisons 
of which affect the heart, should know the 
importance of rest and of relaxation. Men try- 
to fight off influenza as nothing but a bad cold, 
when, on account of the heart, it is much safer to 
stay in bed for a few days, even if the influenza 
be of a mild form. 

Third: A wide class of heart diseases due to 
errors of living, dissipation in eating, drink- 
ing or other vicious habits. This class of dis- 
eases may be greatly relieved by correcting 
the bad habit, stopping the cause, by the liv- 
ing of a rational life. Fourth, a class of heart 
and blood-vessel diseases which are due to 
changes in the tissue, coming on with age. These 
are largely diseases of men, being comparatively 
seldom found in elderly women, due, no doubt, 
to the greater exposure the man must naturally 
endure from the irregular life of his vocation 
or inclination. Rheumatism is so often a cause 
of heart trouble that I consider it an advanced 
symptom or an accompanying symptom of heart 
disease. Indeed I believe there is no acute 
disease so often the cause of heart trouble as Is 
acute rheumatism. 



RELAXATION 

To maintain a normal condition of health In 
the body It is necessary that body and mind have 
their activities and rest in due proportion, undue 
activity, undue rest alike tending to loss of equi- 
librium in power and energy. The self-regulating 
mechanism of the heart is based on this principle. 
Night and day, during sleep or through the waking 
hours, the normal heart keeps up its contraction 
and relaxation, every one of the seventy-two (ap- 
proximately) beats in a minute, followed by a 
corresponding pause or period of rest, during 
which It accumulates energy for the next beat or 
activity. If the equilibrium or relationship of beat 
and pause, of work and rest be disturbed through 
nervous or organic Influence, there Is a resultant 
or casual morbid condition. Being given a fair 
chance, the heart maintains Its ratio of work and 
rest, and should be an example to man in regulat- 
ing his voluntary activities and periods of rest. 
Too much work, prolonged periods of work with- 
out the relative rest, will lead sooner or later to 
enforced prolonged rest or a complete breakdown. 



WHAT PATIENTS SHOULD DO 13 

We are told that certain plants could not be 
made to bloom before their time, before their 
period of rest was over, until florists conceived 
the idea of putting them to sleep with an anaes- 
thetic. They have now been forced to bloom, but 
both plants and flowers are pale and anae- 
mic. 

Modern life, with its increased speed of activity 
along every route, Its excitement, Its great busi- 
ness, professional or financial responsibility and 
strain, its educational, social and pecuniary com- 
petition, its luxurious living multiplying the details 
of care in the home, a place primarily designed for 
rest, producing high tension in man and woman, 
tension of the nerves and arteries, tension of mind 
and body, creates a need for practice of sys- 
tematic relaxation so greatly neglected In our time 
by the majority of men, and especially by Amer- 
icans. The multiplicity of newspapers, the hurry- 
ing through the columns at the breakfast table, on 
the train, on the way to business ; the moving-pic- 
ture shows, with their ever-changing scenes, pro- 
duce nervous excitement in the mind of child and 
adult alike. In an hour the mind is obliged to 
cross the wide ocean, to visit the leading cities of 
Europe, to review its standing armies, and innu- 
merable hurried sensations are conveyed to the 



14 WHAT HEART PATIENTS 

brain. Having had the telephone, we can now not 
live without it; but while it simplifies life in some 
ways, it has, on the whole, much increased the 
pace and strain. 

The increased nervousness and tension to which 
modern conditions conduce have multiplied the 
instances of arterio-sclerosis and heart trouble. 
The importance of exercise is taught and dwelt 
upon in most of the schools. I wonder how often 
what Professor William James calls the '^ Gospel 
of Relaxation" is preached. I believe that teaching 
rules of judicious and regular mental and bodily 
relaxation to the young, and the practice of the 
same in middle life, would be a most potent agent 
in preventing diseases of the arteries and heart 
and in assisting nature to overcome disease where 
it is the result of toxic poison. The agents of 
work and pleasure, of culture and development are 
Increasing at a tremendous pace. We would not if 
we could put ourselves back into a slowly moving 
century, when the news was called out by the town 
crier, who made his way leisurely through the 
streets. Professor James quotes a Scottish med- 
ical man as saying, " You Americans wear too 
much expression on your faces. You are living 
like an army with all its reserves engaged in action. 
.. . . You really do carry too much expression, 



SHOULD KNOW AND DO 15 

you take too Intensely the trivial movements of 
life." 

Rest Is often so necessary to a weakened circu- 
lation that a few days' absolute rest at the proper 
stage of the trouble may mean as many years 
added to the life of the patient. In preventive 
treatment, rest is very essential, particularly after 
any of the infectious fevers which induce heart 
disease. In fact, in many of these fevers, in the 
convalescent stage, absolute rest is the only pre- 
ventive measure necessary. The person whose 
heart Is weak or overworked should have one or 
more periods of complete rest daily. He should 
He in bed or on a couch with closed eyes, relaxing 
every muscle, refraining from conversation and 
reading, and making his mind as nearly a blank 
as possible. After an illness, a prolonged rest 
may be necessary, to give time to the weakened 
heart walls to regain their normal strength. This 
often requires several days or weeks, or even 
months, according to the severity of the lesion 
or the ability of the heart to do Its work. In 
this condition one must exercise patience, bearing 
in mind, however, that it Is far better to remain 
In one's room a week too long than to put an 
extra tax on the weakened heart one hour before 
it Is prepared for additional work. 



CLOTHING 

The fitly clothed person Is not necessarily the 
one who goes to the best dressmaker or tailor. 
The fitness of clothing depends upon many things 
— first, upon the individual's needs or his condition 
of health or ill health; second, on the external 
conditions, such as weather, etc.; third, on 4:he 
bodily activity or his programme of the hour or 
the day. The best fitting garments may be made 
with a strange disregard of their use, or their 
relationship to the comfort or protection of the 
individual — the utility of dress being lost sight of 
In the desire for apparel which adorns, when the 
matter of combining the two Is very simple. 
Man, with his superior intelligence, might be ex- 
pected to show great discrimination In the matter 
of clothing instead of the astonishing absence of 
common sense he so frequently exercises In dress 
and the great role which tradition, looks and 
fashion play In the choice of clothing for male 
and female, while the object of protecting the 
body and at the same time covering It, has a sub- 

i6 



WHAT PATIENTS SHOULD DO 17 

ordinate place In the Individual's attention and 
thought. 

Unlike animals, man has the power to choose 
his own clothing for the particular climate or 
weather, to protect himself against snow, rain or 
intense sun's rays. He knows something or much 
about his body, about his Internal organs and their 
functions, and with average intelligence and ob- 
servation is able to clothe himself rationally. In 
spite of mankind's superior advantages. It is a 
question as to whether the majority of human be- 
ings are as suitably clothed as animals, since most 
persons wear too few clothes, or too many, or not 
the right kind for the protection of the body under 
varied conditions, or those which afford free activ- 
ity to the bodily organs. 

However much the person in vigorous health 
may with impunity violate the laws of hygiene in 
dress, such violation should be strictly refrained 
from by those who have heart trouble, whose cir- 
culation and blood vessels are affected. Such per- 
sons have less resistance to changes of tempera- 
ture, and must hence guard against congestion. 
The departure from the normal standard of 
health may require relative change of clothing. 
In weight, In warmth, or in texture. Heart 
trouble is closely associated with rheumatism, a 



1 8 WHAT HEART PATIENTS 

disease which is aggravated by carelessness In 
clothing as regards protection. The reduced 
strength of the Individual, In many instances, 
makes the matter of selecting garments which 
protect without burdening, one of importance. 
Where repair of the heart, the nourishment of the 
tissues, the free circulation of the blood, is essen- 
tial to recovery, clothing which binds may retard 
or prevent repair, if it be not the cause of absolute 
harm. 

Since the nerves have much to do with the 
maintenance of health, with the repair of the 
body, and are likely to be very sensitive In diseases 
of the heart and blood vessels, it Is easily seen 
what mischief may be done by uncomfortable 
clothing and the consequent local or general 
nervous Irritation. 

Where the circulation is impaired, there is often 
a tendency to the wearing of too heavy or too 
many clothes, not only out of doors, but in the 
house as well, and the more hurtful indulgence 
of sleeping at night In garments which have been 
worn in the day, thus interfering with the natural 
outlet of the waste of the body through the skin, 
and permitting the reabsorptlon by the blood of 
the poisonous impurities of which it has tried to 
rid itself. 



SHOULD KNOW AND DO 19 

Impaired circulation Is frequently accompanied 
by a sensitiveness to cold and an abnormal 
fear of air, whether cold or warm, coming 
Into contact with the skin. The more clothing such 
persons put on the worse they get, as all healthful 
evaporation and elimination of the skin is hin- 
dered and their resistance to cold and disease 
greatly diminished. Fresh, well-aired, warm, dry 
garments, not more than are sufficient, should 
be put on at night, and well-aired, fresh under- 
clothes in the morning, after the body has been 
bathed and thoroughly dried with a towel. Those 
who wear heavy clothing In warm rooms In the 
house, though they think to avoid colds by such 
measures. Increase their liability to colds by the 
retention of moisture next to the skin, the reduc- 
tion of resistance by the reabsorption of waste 
poisons, by the difficulty of wearing enough addi- 
tional clothing on going out into the cold to pre- 
vent congestion and Its harmful effects. 

The person who is sensitive to cold should 
change his underclothes often. The feeling of chill 
which the person of disturbed circulation suffers Is 
not infrequently aggravated by the bodily moisture 
retained by the underclothes. If the individual ex- 
periences a greater feeling of cold In the middle 
of the day than the temperature of the air war- 



20 WHAT HEART PATIENTS 

rants, he should remove his underwear, though 
It may have been fresh that morning, rub off the 
body with a dry towel, and put on dry, fresh 
clothes. Those which he has worn but a few 
hours may be safely donned again the next day, 
after they have hung in the light and air. The 
covering of the feet, both stockings and boots, 
should be changed after active exercise, because 
of perspiration or moisture from the ground. The 
discomfort, which in many cases Is attributed to 
a subjective sensation of cold, not Infrequently 
disappears by the employment of this simple 
method. 

Women often go to the other extreme of 
wearing very thin clothing In the house in the 
winter. If a window or door be opened, there 
is little or nothing to keep the cold air from out- 
side, with the abrupt change In temperature, from 
coming in direct and sudden contact with the skin, 
producing congestion of the skin and internal or- 
gans. Where there Is a predisposition to rheu- 
matism, short sleeves in winter are dangerous. 

Clothing should be sufficient, neither too heavy 
nor too light. It should be right for the special 
climate, temperature, weather and modifying con- 
ditions such as those peculiar to the individual 
or the external conditions. The clothing should 



SHOULD KNOW AND DO 21 

not bind or interfere with the freedom of the 
bodily functions or bodily activity, causing nervous 
irritation or constant muscular resistance. The 
Irritant of the human body does not produce a 
pearl as It does within the shell of the oyster. 
Evening clothes for both women and men are 
likely to give undue exposure In winter unless great 
precautions are taken In providing outer wraps of 
sufficient warmth. Women, however, are the 
worse sufferers — with their low shoes, transparent 
stockings, bare necks and arms. Accustomed to 
hats In the daytime, they have the habit, too, of 
going out bareheaded at night In the dampness 
and chill, from which a carriage top does not 
protect them and which Is the cause of many ills 
or relapses. 

For the Individual whose strength Is to be 
conserved and exercised with care, every ounce 
of clothing worn should have a fair rela- 
tionship to Its utility. Women should dispense 
with lead weights in their gowns and heavy trim- 
mings. Men err in filling their pockets with heavy 
and unnecessary articles, if the clothing Itself be 
not burdensome. Very thick clothing is likely to 
overheat the skin, relaxing it and reducing the 
power of resistance. Persons enervated by heavy 
or very warm garments, have little resistance to 



22 WHAT HEART PATIENTS 

cold germs and congestion and chill. Clothing 
which Is worn on the street should be well 
brushed on coming In or changed, as the person 
who Is not well Is apt to be more susceptible to 
bacteria. 

Let the reader ask himself, " Where does my 
clothing bind the body or Impede the repair 
process which the body endeavours to main- 
tain for Itself and which proper living and treat- 
ment aim to promote? " The woman has heard 
enough about her corset, but has any one warned 
her husband against the tight, high or stiff collar, 
which presses upon and Irritates the great blood 
vessels of the neck or the nerve filaments so In- 
timately related to circulation; against the kind 
of collar button, which spoils his temper, makes 
him susceptible to excitement and to anger over 
trifles, which is decidedly bad for him; against 
shoes, which, without being too small, may press 
somewhere or be an uncomfortable shape for the 
feet. Interfering with the free flow of blood In 
the capillaries and with the comfort and exercise 
of the wearer; against the stiff, heavy hat, that 
weighs upon an already heavy head; the tight gar- 
ters or belt, unconscious agents in disturbing the 
circulating equilibrium of an already impaired 
blood current ! 



SHOULD KNOW AND DO 23 

The women I want to warn against wearing 
very taut stocking supporters, which demand con- 
stant muscular resistance, whether the wearer be 
sitting or standing. Muscular effort is thus inju- 
diciously wasted, the muscles overtaxed, exercise 
becomes difficult or fatiguing and the nerves put 
on edge. It seems strange that disagreeable symp- 
toms are so often ascribed to obscure causes when 
the diagnosis of short supporters is overlooked 
and the addition to their length of an Inch or two 
a simple but efficacious prescription. 

Temperance and good sense should be exer- 
cised In dress as in all things. It Is unques- 
tionably bad for sick or well people to become 
indifferent to the neatness and appearance of 
their clothing. Women's clothes may be pretty 
and becoming without being uncomfortable or 
hurtful, and the mental effect Is decidedly good 
on the wearers and those about them. Men, too, 
should not disregard their appearance as If It were 
all over with them, as if all interest with those 
with whom they come In contact as well as per- 
sonal pride had ceased to exist. Let me say right 
here that it Is important that the person who has 
heart or arterial trouble should keep In touch with 
his friends and with the things which Interest 
him, so long as he does not unduly tax his 



24 WHAT HEART PATIENTS 

strength. Great prudence must be exercised, and 
it is often necessary to prohibit all social and busi- 
ness intercourse because patients show so little 
moderation and judgment. 

In regard to the kind of clothing, whether it be 
woollen or cotton, the former is generally conceded 
as the better for outer garments in moist, wet or 
cold weather, while cotton, it goes without saying, 
is the more comfortable and rational for warm 
weather. There has been much discussion as to the 
relative virtue of woollen and cotton for under- 
wear. The one who tries to wipe up a few drops 
of water from his desk with a woollen cloth, will 
see the reluctance of wool to take up moisture. 
Where there is much moisture given oft by the 
skin, whether in the form of perspiration or almost 
imperceptible moisture, the woollen undergarment 
refuses to take it up and the individual is likely to 
suffer from wet skin. We are reminded * that ani- 
mals clothed in wool do not perspire and that their 
woollen coats are to afford them protection from 
external moisture. Cotton for underwear is rec- 
ommended for its ready power of absorption, the 
rapidity with which it dries, thus keeping the skin 
in a dry condition and less subject to chill. A little 
experiment and observation in relation to external 

* American Medicine, July, 1909. 



SHOULD KNOW AND DO 25 

conditions and personal peculiarities will show the 
Individual which is the more comfortable for him. 
Lisle underwear is uncomfortable for the ma- 
jority of persons because of its hardness of texture 
and its tightly twisted thread, which is slow to 
take up the moisture of the skin. Women are 
likely to go to the extreme in wearing underwear 
far too light and thin for cold weather, suddenly 
chilling and congesting the skin on going out from 
overheated rooms. The outer garments should 
be selected with a view to conserving the heat of 
the body or with a view to radiating it accord- 
ing to the weather or temperature of the rooms, 
as well as to the protection from external moisture. 
Man, by changing his clothes, is able to equal- 
ise the radiation of his bodily heat, to promote 
or retard the evaporation of bodily moisture, 
to protect himself against wet or cold. Between 
the clothing and the skin there should be a tem- 
perate zone. 

Most mothers, of the middle or upper classes, 
evince great watchfulness and judgment in 
clothing their young children properly for the 
preservation of their health. It Is just at the 
period of the young person's life when the great- 
est care and discretion should be exercised, that 
he, or perhaps I should say she^ for It Is the girl 



26 WHAT PATIENTS SHOULD DO 

who suffers most, is given her own sweet 
way, to wear the dress which she likes best, 
whether it be suitable to the weather or not, to 
go out from an overheated room into the cold, 
with transparent stockings and low shoes which 
are in no sense a protection. How many in- 
stances does the physician recall of mothers com- 
ing to him almost in despair as to what to do with 
their frail daughters so reckless of their health. 
Girls are likely to be reasonable if their intellect 
and sense are appealed to. In the first place, a 
girl should be spoken to seriously about herself, 
should know why just at that time in her life she 
cannot afford, for some whim, to sacrifice her 
future health. It seems to me that fathers have 
taken entirely too indifferent an attitude towards 
their daughters, or perhaps it is simply an indul- 
gent attitude. At any rate, the majority of them 
leave this problem to the mothers, when an ear- 
nest word from them at the right moment would 
have great weight. At the time of puberty young 
persons are likely to show some increased arterial 
tension, rheumatism or anaemia, of no serious mo- 
ment if hygienic laws be observed, while disregard 
of such laws may result in serious trouble of the 
blood, heart and arteries in later years. This 
applies to the youth as well as to the girl. 



CLIMATE AND ENVIRONMENT 

The temperate zones, In spite of their good 
name, are practically the home of heart disease. 
The abrupt changes more or less constant in these 
latitudes, are the greatest climatic factors in pro- 
ducing or aggravating cardio-vascular-renal dis- 
ease. America, like other continents, has what 
is called " excessive " climate, characterised by 
marked difference between summer and winter, 
and between day and night — extreme changes 
often taking place within a few hours. Such ex- 
cessive and abrupt extremes are a severe strain on 
the circulatory system of all human beings, and 
it Is only the hardiest who can live year after year 
subject to these extremes without showing the ef- 
fects of strain. 

In the temperate zone, the mode of life, both 
business and social, is much more strenuous than 
in other latitudes. This occasions greater wear 
and tear to mind and body, and the consequent 
premature aging of man. Within the temperate 
zone favoured spots not subject to extreme varia- 

27 



28 WHAT HEART PATIENTS 

tion are found — their latitudinal climate being 
modified by altitude, or proximity of the sea, pre- 
vailing winds, the position of sheltering mountains, 
etc. Hence it is possible for many persons who 
suffer from the ill effects of temperature extremes 
to avoid them by a comparatively short journey 
from home. 

The importance of climatological factors on 
the treatment of the heart and arteries, and on 
the precursory or resultant diseases, is apparent 
from the great number of sufferers sent from 
home by their physicians to a mild summer or 
winter climate. With almost the regularity of the 
migratory birds, the human flocks move northward 
or southward. The best winter climate for these 
persons is one which is mild and dry, with some 
bracing effects in the atmosphere and not so warm 
as to be enervating. In such a winter climate one 
may be out in the fresh air many hours in the day; 
he will be able to take exercise, to walk or drive, 
to have the benefit of sunshine and air, and to 
be more comfortable. No one suffering from 
hardening of the arteries, angina pectoris or weak 
heart should live through the winter months in a 
very cold climate where he is subject to the rigours 
of severe cold or is exposed to the abrupt and 
violent climatic changes of the early spring. Ex- 



SHOULD KNOW AND DO 29 

posure to vicissitudes of temperature is espe- 
cially trying to persons suffering from valvular 
disease or " leaky " heart. Almost all such sub- 
jects having an acquired or inherited predisposi- 
tion to rheumatism, one of the things to be 
guarded against is change in weather or wet, cold 
weather; in fact, anything that may bring on an- 
other attack of this trouble. 

I realise that a large number of persons who 
read these pages will, from various causes, be 
unable to leave their homes and seek a better cli- 
mate at a time when they most need change. Such 
persons I should advise, in a general way, to keep 
their houses well aired and of an equal tempera- 
ture, not too hot, as are most houses in the north- 
ern cities of the United States; that care be taken 
that the bedrooms be well aired before retiring, 
and, when possible, that there be good ventilation 
in the chamber during the sleeping hours. Dur- 
ing the wet, changeable season, the lower ex- 
tremities of the body should be well protected by 
high, strong-soled shoes, long warm stockings and 
warm undergarments. During this season per- 
sons who have suffered from rheumatism should 
not expose themselves to the inclemencies of the 
weather more than is absolutely necessary. Not 
only is a changeable climate, with its many incle- 



30 WHAT HEART PATIENTS 

ment days, bad for rheumatism, but It Is also likely 
to Interfere with the regular out-of-door exercise 
which every person who has a rheumatic tendency 
should take. 

Kidney troubles, like those of the heart, show 
unfavourable symptoms with exposure to abrupt 
changes of weather or climate. Persons who suf- 
fer from defective circulation, from cold hands 
and feet, are happier and more comfortable In 
a warm winter climate, where they can be 
out In the fresh air, than they would be at 
home in a superheated house, hovering over a 
radiator. 

The diurnal variation of temperature. In a mild 
climate, of fifteen, twenty or even twenty-five de- 
grees Fahrenheit, Is likely to be beneficial to the 
average person, providing the temperature swings 
back Instead of progressing. Absolutely equable 
climates are difficult to find, and the only ones 
which strictly deserve the name are in mid-ocean. 
This, of course. Is not a practicable place for 
spending the entire winter or summer. Some 
variation, however, as I have said above, may be 
advantageous as having a toning effect on the 
human system. 

If the evenings are known to be cool, the person 
who goes out in the middle of the day to come 



SHOULD KNOW AND DO 31 

in after sunset, should provide himself with an 
extra coat, to put on when the temperature 
changes. 

Most persons need the bracing effect of some 
variation in the temperature, but few can stand 
repeated extreme changes of heat and cold. Pro- 
longed heat and cold are exhausting or over- 
stimulating to the majority of healthy persons. 
To the average youth, whose heart has greater 
elasticity and power of adjustment than that of 
the person past middle life, the mild climate is 
not essential, except to tide him over to recovery. 
In fact, if he is eventually to make his home in 
an excessive climate, long years of residence in 
a mild climate may deprive him of his adaptability 
to variations and resistance to extremes. 

Some places in the northern latitudes of Europe 
and North America which, in consequence of the 
warm ocean currents, have a very mild regular 
winter temperature, are unfavourable winter re- 
sorts, because of their few hours of daylight in 
the winter months and the little opportunity they 
afford for outdoor exercise or life. In these north- 
ern latitudes there is also likely to be more hu- 
midity in the air and little motion In the atmos- 
phere. Neither of these is conducive to sufficient 
bodily evaporation, and hence these climates are 



32 WHAT HEART PATIENTS 

not to be recommended as winter resorts, because 
of their temperatures alone. 

Large cities seem to have a climate peculiar to 
themselves. This is attributed to different causes : 
the combustion of oxygen in the many factories, 
the atmospheric currents produced by local con- 
ditions, greater condensation of moisture, etc. 
Hence quite different climatic conditions or hy- 
gienic conditions may be observed a short distance 
beyond the city limits. 

Besides the sunshine, the fresh air, freedom 
from chill, the opportunity to exercise which a 
mild climate affords, there is a decided advantage 
in being relieved of the monotony of one's room 
or house. It is good also to have a complete 
change of scene — for the woman to leave the daily 
demands made on her at home; for the man to 
get away from his office and telephone calls. 

Aside from favourable climatic conditions, a 
change in the daily routine of life and of scene is 
observed to be favourable to the reduction of 
nervous and arterial tension and of high blood 
pressure. 

A change, such as a visit to friends or relatives 
in the neighbourhood, is not infrequently attended 
with beneficial results. The danger in visiting, 
however, is that patients are tempted to overtax 



SHOULD KNOW AND DO 33 

their strength, In order to be pleasant and com- 
panionable guests or In unwisely trying to conceal 
their defects and limitations. 

Where the patient Is a good traveller, a long 
journey or voyage incidental to finding a pleasant 
summer or winter climate, may be beneficial — 
if a journey by land, through the Interest in 
change of scene; if an ocean voyage, by the 
fresh air, the regular quiet life, the pleasant 
travelling companions he may meet. On the other 
hand, the journey or voyage may involve a hard- 
ship to one whose vitality is much reduced, in 
which case it is wise to make conditions at home 
as favourable as possible, and to avoid undue ex- 
posure in bad weather. The crossing of high 
mountains which a journey may Involve Is accom- 
panied with little risk If the proper precautions 
be taken, for example, sitting quietly in the seat 
or lying in the berth. Strenuous sightseeing is not 
to be recommended — nor is the frequent changing 
of hotels, with the incidental excitement and con- 
fusion, the packing and unpacking of trunks. 
For the person who cannot afford the expense of 
a long journey, or a winter residence In a mild 
climate, harm rather than good may be the result 
of his leaving home. Under such conditions the 
patient Is likely to worry and fret, to sleep badly, 



34 WHAT HEART PATIENTS 

to economise on his food and comfort by taking 
poor quarters and board. All of these things 
should be carefully considered. For persons who 
are very 111, home Is a good place, with advantages 
and comforts which may more than offset climatic 
conditions. 

For a woman, going away too often involves 
arduous preparations, such as shopping In badly 
ventilated stores, running to dressmakers, stand- 
ing for fittings, and the packing of trunks — all or 
any of which may do her heart more harm than 
the most favourable climate can repair. I recall 
more than one woman who, having regained a fair 
measure of health and hope, by months of the 
most careful and regulated living and treatment 
in a quiet health resort in Europe, has risked los- 
ing all she had gained for the sake of a week In 
Paris and the latest Parisian gowns. 

The man who has heart trouble should avoid, 
as far as possible, worrying details Incidental to 
travel. He should avoid carrying heavy hand- 
bags or suitcases. The physical strain of lifting 
is harmful, as has been said elsewhere; the stretch- 
ing of the body to take down a heavy suitcase 
from a car rack Is also an undue strain. He must 
give himself plenty of time for his train, so that 
he may be spared any nervousness about making 



SHOULD KNOW AND DO 35 

It, and that he may not be hurried in checking his 
luggage, etc. It goes without saying that he must 
not run for street cars and trains, which is said 
to be a strong habit with women, but which seems 
to me much more common to men. 

The man who has to break up old habits, such 
as drinking alcohol, smoking, drinking coffee, etc., 
will find it much less difficult to make such change 
in a new environment. 

Heart trouble, in many cases, is accompanied 
by a cough which is very wearing on the patient 
and is a strain on the heart. Such cases often 
find relief in change to favourable climatic con- 
ditions. 

An excessively hot climate is not favourable to 
a defective heart, though many are less sensitive 
to the heat of summer than to the cold of winter. 
Stout persons who are not able to choose a pleas- 
ant summer climate, must be especially careful in 
hot weather, taking exercise early in the morning 
or in the cool of the evening. If the man be 
obliged to go to his place of business, it is better 
for him to take a few biscuits or a sandwich in 
his pocket for his noonday repast than to risk 
going out into the hot sun for lunch and to have, 
immediately after the meal, the exertion of walk- 
ing back to his office or place of business. Per- 



36 WHAT HEART PATIENTS 

sons whose occupations keep them outdoors and 
who are more accustomed to the heat and light, 
are not so likely to suffer Injury from the midday 
summer heat as are those who spend the greater 
part of time indoors. 

Sunstroke and Heat-exhaustion. — A sunstroke 
with fever Is too grave to be Incurred by 
one whose heart is not normal. Humid heat, 
even without exposure to the sun, often seri- 
ously affects the well and strong, though most fre- 
quently those whose vitality Is Impaired, produc- 
ing lowered bodily temperature, with collapse, the 
heart showing all the marks of exhaustion and 
failure. Persons suffering from heat exhaustion 
should be put to bed with the hot-water bottle 
and advice obtained as quickly as possible. Per- 
sons who know they are susceptible to moist heat 
should be careful to limit their activities. After 
an attack of exhaustion It is well. If not absolutely 
necessary, to stay in bed for a few days to give 
the heart a chance to recover. 

Air and Light. — ^Alr and light have as great 
therapeutic power on the heart as perhaps 
on any other organ, exerting an Influence on 
the blood, affecting nutrition, giving resistance 



SHOULD KNOW AND DO 37 

to infectious diseases, etc. While strong winds 
are to be avoided by the pedestrian, air 
In slight motion is beneficial. It is said that 
indoors, in the ordinary well-ventilated room, 
there is brought in contact with the individual 
scarcely a hundredth part as much fresh air as 
out of doors, and although recent tests seem to 
show that impure air in motion is less hurtful than 
like air when still, fresh air continues to have the 
preference. Air and light also exert a great influ- 
ence on the mind, indirectly affecting all the bodily 
functions. The discussions about the hurtfulness 
of excessive light, or sun baths for the nude body, 
should not lead to avoidance of sunshine. As in 
all good things, extremes are to be avoided. 

Altitude. — The seashore, the hills or a health 
resort, if treatment be advisable, may be chosen 
for the summer season. Many return from a 
summer at the seashore with the general health 
and the heart improved. 

The individual himself should observe whether 
the seashore agrees with him; whether it quiets 
him or excites him nervously, and whether he suf- 
fers from constipation there more than elsewhere. 
If he has had experience at the seashore when in 
health, and remembers how it affected him, he will 



38 WHAT PATIENTS SHOULD DO 

have something to go by before determining 
where he will spend his summer. The hills or 
mountains at an altitude of not over j,ooo feet, 
and probably much lower, are more favourable to 
the health of some persons. Again, while the pa- 
tient's former experience may be of assistance to 
him, it is by no means a sure guide as to how such 
altitudes will be borne with his altered heart con- 
dition. If he finds that his customary exercise 
occasions unusual respiratory embarrassment or 
palpitation; if he suffers from increased gases in 
the stomach or from other suspicious symptoms, 
he had better betake himself to an altitude less 
unlike that to which he is accustomed. Persons 
who have lived for some years on a high plateau 
should change gradually to a much lower level, 
so that the weak heart may not be taxed by having 
to accommodate itself suddenly to the increased 
atmospheric pressure and resistance, and one who 
has lived in the low plain had better likewise avoid 
an abrupt change to the plateau or mountains. 



EXERCISE 

Exercise In the strictest sense of the word is the 
" calling forth of powers," thus implying the pres- 
ence of powers to be called out. The normal 
heart in the healthy body has ability to keep up 
the circulation as well as to store up reserve pow- 
ers for all ordinary and some extraordinary bodily 
activities. 

Exercise, or what is commonly termed " ra- 
tional exercise," is the calling out of this reserve 
without encroaching on the store necessary to keep 
up the circulation of the blood and the nourish- 
ment of the tissues of the body. It is obvious 
that when the heart is much weakened or dis- 
eased, its reserve powers greatly reduced or ex- 
hausted, with little more than enough vigour re- 
maining to perform the functions necessary for 
the life of the body, all attempt to use this 
power in another way Is homicide. In other 
words, '' exercise " should not be confounded with 
'' exertion," which is a pushing out or forward 
with laborious strain. 

The heart may be weakened by lack of exercise, 

39 



40 WHAT HEART PATIENTS 

disuse, or by frequent or prolonged exertion, 
abuse. The first is apt to be concurrent with 
sedentary habits, the second with extraordinary 
physical or mental activity, with nervousness, or 
with poisonous infections of the system, over 
whose harmful effect the patient may have no 
direct control. 

The natural vigour of the heart should not be 
permitted to diminish by disuse, neither should 
it be unduly exerted or strained, nor should the 
reserve power, essential to the upkeep of the 
bodily nourishment, be directed to mental and mus- 
cular effort. On the other hand, the weakened 
heart muscle, the hypertrophy or the dilatation 
may be the result of too great or too oft repeated 
demands on the organ. 

One man sits at his desk all day, failing to 
exercise the normal powers of his heart, which in 
consequence become more and more indolent and 
barely keep up a sluggish or inadequate circula- 
tion. Another, by his life, habits, environment, 
overtaxes his heart directly or indirectly every day 
of his life. 

It is apparent that there can be no develop- 
ment of natural powers without exercise — there 
can be no health of body or vigour of mind where 
exercise is entirely eliminated. The unused mus- 



SHOULD KNOW AND DO 41 

cle becomes flabby, the power not called Into use 
diminishes. 

The normal heart In a healthy, vigorous body Is 
capable of remarkable feats of temporary exertion 
without harm to the organ, unless such extraordi- 
nary demands be made too often or too long. 

Since rational exercise Is of such Importance 
where the powers of the organ are normal, how 
much more important It Is where there Is some 
departure from the normal and the reserve store 
is low. The power of the heart muscle, when 
hampered by defective valves, by weakened walls, 
or by arterial constriction, may be so embarrassed 
as to be forced to do more than Its normal work 
In order to maintain even the circulation. The 
greatest care should be taken that the organ so 
weakened or hampered be properly exercised, but 
not strained. 

Where marked heart failure Is present and the 
organ shows Itself unable to do Its everyday 
work, the patient should be kept In bed, as every 
extra demand Is fraught with danger. 

Where the heart has little reserve force be- 
yond that which Is essential for keeping up the 
circulation of the blood. It will be clear, even to 
the layman, that rest Is Imperative In order to 
give the organ an opportunity to recover Itself. 



42 WHAT HEART PATIENTS 

Where marked signs of failure or exhaustion are 
manifested, the only safe thing for the patient to 
do is to go to bed and stay there until his phy- 
sician, whose careful attention he should have at 
this time, gives his permission for him to get up. 

I wish to emphasise that at this period every- 
thing may depend on the patient's willingness to 
comply with the injunctions imposed on him, and 
that if he get up too soon the penalty of ill con- 
sequences is likely to follow, from which sincere 
but tardy regret will not exempt him. No muscu- 
lar activity, except that which is accurately pre- 
scribed for the particular person, should be in- 
dulged In by one whose heart has barely the power 
to keep up the circulation. 

Exercise in the therapeutic sense of the word is 
as impossible where there is an absence of reserve 
heart-power as it is for a man to take a coin out 
of his purse when there is no coin therein. 

The miser who hides his savings in his sock 
does not receive the Interest which the judicious 
use of his money would bring, while the extrava- 
gant, improvident person or the unfortunate one, 
whose principal has been greatly reduced, will 
have to use great care and discretion in the Invest- 
ment of the little remaining or find himself bank- 
rupt on the proverbial rainy day. It stands to 



SHOULD KNOW AND DO 43 

reason that the person whose heart Is not normal 
should be sure that he Is not wasting or diverting 
his already reduced heart force. 

The suggestions which follow In this chapter 
are for those who are able to be up and about; 
whose reserve-power principal Is below par, but 
who may regain a comfortable living by a rational 
course and by being neither apprehensive nor 
reckless. 

Very abrupt changes In the manner of life or 
In the amount of activity are unadvisable for the 
person In average health, for the heart needs time 
to accommodate itself to the increased or dimin- 
ished demands made upon it. The man who Is 
accustomed to an active outdoor life may suffer 
great Injury by confining himself steadily to his 
desk, while the professional man or brain worker, 
who leads a sedentary life, should give himself 
careful and graduated training before engaging 
In sports, long tramps or hlll-climblng. Heart 
strain is frequently produced by just such indis- 
cretions. The soreness of the muscle of the leg 
or of the arm, unaccustomed to climbing or tennis, 
will do no harm in itself. It may indicate, how- 
ever, especially when the heart is not normal, that 
too sudden and unaccustomed demands have been 
made on that organ, as well as on these muscles, 



44 WHAT HEART PATIENTS 

and that prudence suggests the gradual training 
of both. It must not be lost sight of that there 
IS an essential difference in the amount of activity 
which constitutes beneficial exercise for the person 
whose heart is diseased or hampered by hardened 
blood vessels or embarrassed by other organs, 
and for one whose heart is normal and not de- 
ranged or disturbed. 

Some persons become timid, and oppressed with 
fear and apprehension, as soon as they are ad- 
vised to restrict their activities. This is a very 
unfortunate thing, as they are thus apt to 
curtail their exercise too much, to worry about 
everything they do, and to brood in the house, 
when exercise, air and light would give strength 
and cheer, and in many instances a fair or entire 
recovery to health. I have in mind a lawyer, who, 
having learned that he had heart trouble and 
that he must avoid sudden and prolonged physical 
effort, was seized with the conviction that he was 
doomed. For years, when he walked out it was 
with his head down and with fear accompanying 
every step. At last one day he fell on the street, 
was carried into the nearest house and later taken 
to his home, where he was for some time kept in 
bed. When he was able to be about again, it was 
with greatly increased fear. Finally his physician, 



SHOULD KNOW AND DO 45 

knowing that the patient was exaggerating the 
seriousness of his condition to such an extent that 
he feared to take the sane exercise so necessary 
at this stage for his restoration to health, ordered 
him to saw wood, beginning with one stick the 
first day and increasing his task as his strength 
grew. The lawyer protested, asserting that he 
would never survive ; but the doctor Insisted, and 
finally had his way. Before many months the 
lawyer was sawing enough wood for his fireplace 
and walking out on the street with head up and 
with confident step. He has been walking that 
way for at least twenty-five years since and Is still 
an active, Influential man In his community. 
While there are very few persons for whom this 
particular kind of exercise should be recom- 
mended, there are no doubt legions who because 
of their harmful and unjustified fear and the 
consequent restriction of their activities need to 
be set to sawing wood, figuratively If not literally. 
Still another class of persons are so Impatient, 
Impulsive or Impetuous that they recklessly or 
abruptly rush at everything they undertake, doing 
themselves harm at every turn. The person who 
has heart trouble should ascertain as nearly as 
possible what his power-resources are and what 
his limitations. The health expert will be able 



46 WHAT HEART PATIENTS 

to give a good average estimate, though not with 
the mathematical accuracy that a bank accountant 
can of one's pecuniary reserve. It Is easy for 
the Individual who Is not over-apprehensive to 
know by the cardiac discomfort or distress which 
he feels when he Is Imprudently nearing or cross- 
ing the boundary of his circumscribed power. He 
should keep In mind that much depends on his 
taking a sane view of the situation, on modifying 
his activities — increasing them or diminishing 
them — and for taking more frequent periods of 
rest or relaxation as his condition may seem to 
demand. The person whose heart response is 
diminished below the normal should not continue 
his exercise, whether walking, games, or gym- 
nastics, beyond the point of cardiac fatigue, which 
manifests itself in various ways — by shortness of 
breath, palpitation or other forms of discomfort 
or distress. Whoever the person may be and 
whatever his peculiarities, it Is well for him to 
bear In mind the importance of keeping within 
this limit, of heeding the warning on the ap- 
proach to the boundary line of danger. 

Walking. — Where walking is admissible it is 
one of the very best forms of exercise. Short 
walks, with frequent Intervals of rest, are, on the 
whole, to be recommended above long, unbroken 



SHOULD KNOW AND DO 47 

ones, as are short periods of exercise of any and 
every kind. Pleasant companionship is valuable, 
but not so the companionship of the over-solicitous 
person, or of the over-exciting or the uncongenial 
one. There are exceptional instances where exer- 
cise may be continued for longer periods, but since 
the patient himself cannot determine these, he 
should observe the danger signals and keep on 
the safe side. When I advise a patient to walk 
as much as he can without feeling fatigue, I don't 
mean for him to walk a mile or two from home, 
with no thought of return until unpleasant symp- 
toms show themselves, and when the entire dis- 
tance must be covered again, with every step ex- 
hausting, instead of exercising, the energy of the 
heart. The head and the heart may be tired long 
before the feet grow weary. Walking against the 
wind and talking against the wind should be 
avoided, if not prohibited altogether. 

The one whose heart Is not strong should be 
the listener In his daily walks, reserving what he 
has to say for the rests on the wayside or restrict- 
ing his answers to " yea and nay." Especially 
is talking to be avoided while climbing stairs or 
in making an ascent, however slight. Stair 
climbing, especially one flight, is usually permitted 
to the person who is able to walk about. It 



48 WHAT HEART PATIENTS 

should, however, be done very cautiously and 
slowly, with frequent stops, if there be any dif- 
ficulty in breathing. Rest should be taken before 
climbing stairs after coming in from a walk of 
any distance. The strain may be greatly de- 
creased by making the ascent backwards. The 
carrying of heavy parcels, of books, etc., should 
be avoided on walks and in going up and down 
stairs in the house. Heavy clothing, that which 
has more weight than is necessary to protect the 
body, should not be worn. The long fur coat, 
so effective in the wind, is too heavy for any but 
the strongest pedestrian. An extra undergarment, 
to be laid off on coming in, may afford sufficient 
warmth and protection for the cool day, without 
adding any burden of weight, while a light wrap 
may be carried to guard against sudden cooling 
off. Comfortable shoes, clothes which leave the 
body free for the muscular activity, are not unim- 
portant. The feet must be kept dry. In the 
parks and on the walks in many of the European 
health resorts the benches are provided with foot- 
rests, a safeguard against the moisture of the 
ground. Sitting on the ground is attended with 
risk for persons with predisposition to rheu- 
matism. 

Nature studies or amateur photography often 



SHOULD KNOW AND DO 49 

afford a pleasant and diverting interest, not only 
in keeping the patient outdoors in the fresh air 
but in giving some purpose other than that of 
health-seeking to his walks. Mountain climbing 
must be refrained from. Strenuous mountain 
climbing should not be undertaken by any one, no 
matter how well he may think himself, without 
an examination and an assurance that it may be 
done with safety. It is folly for the brain worker, 
who has been confined in his office for months, 
who takes little or no exercise, or who, if he walks 
to and fro from his place of business, goes over 
level, paved streets, and who, besides, is accus- 
tomed to the atmospheric pressure of the low- 
lands, to undertake mountain climbing without 
gradual training and without knowing something 
about his physical condition. It is folly of this 
kind that brings on many of the heart troubles. 
If there is already high blood pressure and ten- 
sion in the arteries, the added work and tax on 
the heart will involve a great element of risk. 
At certain health resorts, which afford a variety 
of walks at different degrees of elevation, the 
gradual ascent is prescribed for selected cases of 
weak heart or for the obese, the effect of the 
gradual increase in ascent, pace and distance being 
carefully watched. 



50 WHAT HEART PATIENTS 

Walking or other exercise should not be in- 
dulged in for an hour or more after a meal has 
been partaken of. Neither should exercise be 
taken on an empty stomach nor immediately be- 
fore or immediately after bathing. Exercise 
should be taken regularly and, if possible, in the 
open air. Those with rheumatic tendency must 
avoid exposure in bad weather. 

It is difficult to decide whether the automobile 
has done more harm or good. Where it has 
taken city people into the country; where business 
or professional men have been attracted from 
their offices; where the women have been invig- 
orated by the fresh air instead of coming home 
from teas and receptions tired from standing and 
talking and the confused sounds of voices ; where 
walking or riding is too much of a strain on the 
heart, the automobile has been a great benefactor. 
On the other hand, I am mindful that many men 
and women are forgetting how to walk, because 
of their cars; and just how responsible the car 
may be for diminished or dwindling heart power 
it is impossible to say. High-speed touring is too 
exciting for one whose heart is not strong; motor- 
ing in crowded streets, or over-fatiguing tours, are 
to be avoided, as well as talking against the wind. 
Sudden muscular effort, jumping off and on street 



SHOULD KNOW AND DO 51 

cars, running for trains must be abstained from 
when the integrity of the heart is at all questioned. 
Tennis is too violent an exercise for the middle- 
aged person, who has heart trouble. It is, how- 
ever, often permitted to young people whose 
hearts show some irregularity. No risks should 
be run, especially after an acute disease, when the 
organ must have time and protection to recover 
itself. 

Moderate bodily activity, muscular contraction 
and relaxation facilitate the nourishment of the 
tissues of the body and the healthful exit of the 
blood from the capillaries. With every movement 
of a muscle, and with every contraction, the im- 
pure blood charged with the waste, poisonous 
matter is expelled and hurried on its way through 
the veins, while a fresh supply of blood carrying 
food for the tissues, rushes in. 

While judicious exercise promotes the nourish- 
ment of the tissues of the body and the healthy 
stimulation of the activity of its organs, imprudent 
activity may overfeed, while undernourishing, the 
tissues, overwork the heart and overstimulate all 
of the organs. 

Intemperance or dissipation of energy or power 
is apt to produce in the normal system a condi- 
tion of inefficiency, while in the system already not 



52 WHAT HEART PATIENTS 

up to the normal standard there will result a par- 
tial or complete loss of balance. 

The processes by which judicious exercise 
strengthens the heart, improves digestion and as- 
similation, promotes elimination, and the proc- 
esses by which injudicious exertion upsets the 
equilibrium and harmony of the system, are many 
and subtle. 

Many of the mistakes made with children are 
unpardonable. How often are children sent out to 
play and to indulge in excessive activities after 
acute attacks of fever, diphtheria and rheumatism 
from which they have apparently recovered, while 
in reality the heart is still suffering from the 
poisons of the acute disease. How often, it is sad 
to record, must the blame be attributed to the 
parents who, through ignorance or economy, dis- 
continued medical advice as soon as the child 
was able to be up ! 

Many an adult who reads these pages may have 
an infantile history of this kind which is responsi- 
ble for his present trouble. Over-cautious par- 
ents, on the other hand, may harm their children 
by detaining them too long as prisoners in their 
room or bed when moderate outdoor exercise 
would do them good. 

No definite rule can be laid down here for 



SHOULD KNOW AND DO 53 

exercise after acute illness, especially for children. 
I want, however, to emphasise the importance, 
after the individual is up, of watching the condi- 
tion of the heart, and of regulating the exercise, 
and to impress on the parents that neglect in this 
matter may lead to serious heart trouble. Even 
when the greatest care is taken, children present 
a difficult problem, so prone are they to neglect 
caution in their play and to indulge in romping 
games which, while the heart is still suffering from 
the effects of the acute disease, may produce irrep- 
arable heart defect. Such children should be 
watched in their play, until it seems safe for them 
to be unrestrained. The sooner they can with 
safety be like other children in their activities the 
better. It is bad for a young person to put too 
great restraint on himself, to grow up thinking 
too much about himself and restricting to an un- 
reasonable degree all his movements. 

With the greater number of young people, when 
proper care has been taken in the beginning, it is 
only a question of a little time until they may be 
permitted to participate in rowing, horseback- 
riding, swimming, dancing — all, however, in mod- 
eration. Racing for boys is attended with danger, 
because of the feeling of competition which urges 



54 WHAT HEART PATIENTS 

them beyond their strength. Football Is too vio- 
lent and exciting. Marathon racing, needless to 
say, is on the prohibited list, and I believe that 
few boys, even the most robust, should attempt 
this race, especially at the period of puberty, when 
the system Is readjusting Itself. 

The kind of exercise which the Individual en- 
joys should be permitted, unless there are signs 
that It causes undue exertion, or the conditions 
be such as to make the experiment unwise. 

Golf Is a splendid form of exercise for many 
persons, old and young, suffering from heart 
troubles, not only for the exercise Itself, but for 
the mental effect produced by the interest In the 
game. Where driving is considered too active, 
the patient may Interest himself in putting, or ap- 
proaching. Outdoor games are always preferable 
to indoor ones. 

Cards, and especially card parties, are too ex- 
citing to most heart patients, producing sleepless 
nights. A quiet game of cards may be Indulged 
in early In the day, but progressive parties, play- 
ing for stakes or prizes, games In the evening, 
should be avoided always. 

Massage Is a passive exercise, which may be 
beneficially employed where active exercise Is at- 
tended with danger, or it may be a valuable sup- 



SHOULD KNOW AND DO 55 

plement to active exercise, especially where the 
latter is very restricted. 

Massage must be given with a view to the in- 
dividual needs and condition of the person, and 
the effects on the heart and blood vessels care- 
fully watched by the medical adviser. Heart gym- 
nastics, passive movements, so very beneficial in 
given cases, must be prescribed with discrimina- 
tion. Passive exercise, like active, should be re- 
frained from immediately after meals. 

Massage, an excellent method of passive exer- 
cise when used in the proper cases, should be given 
by an expert who thoroughly understands the con- 
dition of the patient as explained to him by the 
physician whose general or special supervision is 
very essential. If an otherwise healthy person has 
a pain in his arm, back or leg, a good massage will 
in most cases be beneficial; but he should, if he 
love reason, heed the warning against indiscrimi- 
nate pounding and rubbing when such a vital organ 
as the heart is below par. In many cases, where 
even very restricted active exercises unduly tax 
the heart, quite rigorous passive exercises such 
as massage may be administered with benefit, but 
it should be borne in mind that massage is a form 
of treatment that, like a powerful drug, should 
be prescribed and the effects watched carefully. 



S6 WHAT HEART PATIENTS 

Besides massage, there are various medical gym- 
nastics and movements which, like other forms of 
exercise in proper degree, tend to promote the 
elimination of waste and to increase the tone of 
the heart walls, increasing the strength and work- 
ing capacity of the organ. They must, however, 
be given with great discretion, and the results care- 
fully watched and discontinued if the signs are un- 
favourable. 

A system of Swedish movements, known as the 
*' Ling movements," or somewhat modified as 
" resistant movements," are of undoubted efficacy 
in certain selected cases of heart trouble. The 
movements consist in extending and flexing arms, 
legs or body against the uniform resistance of an 
experienced operator. All such exercises and 
movements are forms of treatment and should not 
be taken without medical supervision. 

It should be kept in mind that age imposes nat- 
ural and normal restriction, which are not the 
result of disease, and that the man of seventy-five 
has a different normal cardiac response from the 
one of twenty-five; that while right living and 
proper treatment may prevent premature age, 
from which so many suffer, no human being has 
the power to make himself or anybody else 
younger than he actually is. 



i 



SHOULD KNOW AND DO 57 

Lifting puts a great strain on the heart, as It 
Involves stooping and bringing the body back to 
an erect position, In addition to raising some 
weight. Lifting suitcases or heavy travelling- 
bags should be avoided, as well as stretching to 
take them out of racks overhead. There should 
be some way to save the man from explanations 
or the hurtful compliance with correct social 
forms. He Is too sensitive to permit a lady to 
lift or move her own heavy chair or to let her 
pick up her own handkerchief which has fallen, 
or to be seated, while she thoughtlessly remains 
standing. 

Women who have heart trouble sometimes 
suffer exhaustion after washing their own hair 
or even from dressing It, If the hair be heavy 
and hard to arrange. Sudden muscular effort, as 
running for cars, jumping off and on moving cars, 
should be refrained from by every person whose 
heart Integrity Is at all questioned. 

After exercise there should be a period of rest. 
In the recumbent position, unless contralndlcated. 
After meals there should again be rest or absti- 
nence from muscular activity. 

Rolling on the floor to reduce obesity is by far 
too strenuous a measure for any but the very 
vigorous. Although the method seems quite com- 



58 WHAT PATIENTS SHOULD DO 

mon among women, I hesitate to warn against It, 
lest some new mischief be suggested, as was done 
by the oft-quoted over-anxious mother who, be- 
fore she went from home to spend the day, warned 
her children against everything she could think of 
that might do them harm, and called back as a 
parting message: "Children, don't put beans up 
your noses." She had gone but a short way when 
the neighbour ran after her to tell her that all the 
children had beans up their noses. 

The average man who has passed middle age — 
the age of forty or fifty — should consider that the 
range of the development or expansion of his 
powers has been reached, and that the range even 
in the healthy person becomes gradually, from this 
time on, smaller and smaller. The flexibility and 
response of the heart and arteries being dimin- 
ished, no such active demands should be made as 
in youth when the powers naturally Increase and 
grow in strength. 

The importance of the personal element makes 
It impossible to lay down absolute rules of exer- 
cise, which must necessarily vary, not only accord- 
ing to the particular heart trouble, the constitu- 
tion, the mode of life of the individual, but accord- 
ing to the personal temperament as well. 



DIET 

•'I commend rather a diet for certain seasons than frequent 
use of physick: for those diets alter the body more and 
trouble it less." — Bacon. 

Diet is as necessary to the maintenance of health 
and the restoration of impaired health to civilised 
human beings, as food is for the maintenance of 
life for every living creature. Diet is man's food, 
not food as foodstuff alone, anything capable of 
sustaining or nourishing the body, without specifi- 
cation of circumstance or condition. Most people 
think of diet as a strict regime, as abstinence from 
the kind or amount of food to which they are ac- 
customed, whereas diet is nothing more than ra- 
tional food, the kind which should distinguish that 
of man from that of the animal, a factor in the 
preservation of health for the well and an im- 
portant curative agent for the ill. Again, many 
people think that if the chemist proves that a 
doubtful substance has food qualities, that the 
matter is settled, and that henceforth there 
should be no discussion as to its being good for 
man. How often we hear, " but Professor X says 
alcohol is a food," or " Professor A says coffee 

59 



6o WHAT HEART PATIENTS 

Is a food," as if the question of food quality were 
of the foremost importance. In fact, it is of little 
moment in comparison with other qualities in de- 
ciding whether coffee and alcohol have claim to 
a place in man's diet. 

Diet implies choice and system — the selection 
of forms and kinds of the various articles of in- 
take, regularity in eating and amount of the daily 
supply of the body. 

In choice of supply, man should be governed 
not alone by the experience of mankind or by the 
results of science, but by the two methods of 
knowledge combined. Experience seems a slow 
but cruel teacher, and the different races of men 
dull or Indifferent pupils, through the long cen- 
turies, since year after year and century after 
century they have made the same hurtful or fatal 
mistakes in eating and living. In the past, men 
were governed more by necessity of environment 
and conditions in their choice of food than they are 
to-day, as well as more by their ignorance of the 
chemical composition, energy values, the digesti- 
bility and assimilability as estimated in modern re- 
search. They were no doubt many times the vic- 
tims of circumstances, as well as of ignorance. 
To-day, with our ships and trains bringing the 
produce of the world to our ports and inland 



SHOULD KNOW AND DO 6i 

cities, with the vegetables and fruits from the 
north and the south at all seasons, with tests of 
food values, as to the kinds and amounts suited to 
man, had for the asking. It Is strange that men con- 
tinue to eat irrationally, that appetite is the chief 
regulator or irregulator of their body supply. 
Appetite is certainly a blessed thing when It is the 
former, and a Nemesis when the latter. Men who 
are wont to overindulge their appetites or whose 
natural appetites have become perverted, are 
likely to go on, in spite of warnings, until pain and 
suffering make them turn from every dish with an 
unpoetic Interpretation of Shakespeare's : '* This 
may prove food for my displeasure." Dietetics 
is not an exact science. Laboratory tests and 
methods of food values, digestibility, etc., while 
valuable supplemental guides, will never become 
substitutes for clinical or personal experience. 

To the reader who asks: "What has all this 
to do with heart trouble? " let me say that the 
matter of giving the body proper supplies Is one 
of foremost Importance In the preservation of the 
health of man. Irrational eating plays an impor- 
tant role In the cause and aggravation of diseases 
of the arteries and the heart. Auto-intoxication, 
with the slow or rapid poisoning of the heart and 
arteries, is In many instances the result of too 



62 WHAT HEART PATIENTS 

much food, or of food not suited to the person 
or to his condition, while malnutrition, with the 
tissues hungering, the heart muscle weakened. Is 
often due to lack of sufficient food in quantity or 
error In quality. 

It is with some hesitation that conservative 
physicians employ the term auto-intoxication In 
speaking to their patients because of the loose 
use or abuse of the term by irregulars and the 
danger of erroneous deductions on the part of 
laymen.* 

The man should come before the disease. The 
very restricted dietary regime which the theorist 
or faddist has assumed to starve his disease, is 
likely to starve the man first and the disease sec- 
ondarily. In other words, the diet should be such 
as to keep up the nourishment of the 'body, and 
selected and regulated In reference to the par- 
ticular condition of health or disease. 

It may be a lowered power of resistance which 
has given the disease opportunity to Invade the 
system, hence any course which reduces the de- 
fence of the body should be avoided. There are 
other forms of " The lowering treatment " than 
that of frequent bleeding of the patient to which 

*Auto-intoxication, — poisoning by faulty metabolic products 
elaborated within the body, Gould's Medical Dictionary. 



SHOULD KNOW AND DO 63 

George Eliot refers, the most common of which 
is undoubtedly due to errors in diet, to under- 
eating or overeating, to irregularity, and to in- 
judicious selection of articles of food.* 

In extreme cases of heart failure the patients 
should be put to bed and given nothing but milk 
until medical advice can be had. Then is the time, 
if not before, that they cease to be cases to be 
advised in a general way — they are the " Johns 
and Elizabeths " who must have individual study 
and care, whose diet must be under strict daily 
control, until an improved condition is estab- 
lished. 

As I have said elsewhere, the suggestions here 
given are not for such persons, but for those who 
are up and about, who are able to be more or 
less active. 

First, the diet of those for whom we are 
writing is a liberal one — varied and mixed, 
including the kinds of food they like, unless con- 
traindicated by the individual symptoms. With 
impure and adulterated foods absolutely excluded 
from the menage, there is an oft-expressed opin- 
ion that the kind of food man eats is not of so 

♦The great value of venesection in certain instances of 
heart trouble is not to be underestimated. It is the indis- 
criminate bleeding of patients formerly practised which is 
condemned. 



64 WHAT HEART PATIENTS 

great Importance as how much he eats and how 
he eats. As a rule, the average person with 
heart trouble is able to take a normal diet, or one 
but slightly modified from the normal, if it be 
proper and well regulated. 

One hears a great deal about the poor people 
who are underfed, and little or nothing of the 
great mass of well-to-do who suffer from irra- 
tional eating, more commonly from overeating 
than undereating. That irrational eaters are 
multiplying daily is attested by the large and ever- 
Increasing number who crowd the offices of stom- 
ach specialists and who visit health resorts, seeking 
rehef from the effects of irrational eating, or from 
Indulgence of overeating. The Americans and 
English are heavy sufferers from dietetic errors. 
One well-known German stomach specialist dubs 
America the *' Paradise of the Stomach Specialist." 
Indeed It has been charged that the virility of our 
nation is becoming jeopardised by our irrational 
food Intake. This seems rather unwarranted if 
one consider how much more the average well- 
to-do German eats than the American, but not so 
surprising when we recall the American weakness 
for hot bread and pancakes early In the morning 
and his mince and pumpkin pie at dinner late in 
the evening. 



SHOULD KNOW AND DO 6s 

There are three classes of serious mistakes In 
diet: 

1. Most healthy men eat too much. 

2. Many persons suffering from heart trouble 
eat entirely too little and are under-nourished. 

3. About 99 per cent eat Irrationally, In choice 
of food, quantity, manner or time of consumption 
of same. 

These errors are so often met with In cardio- 
vascular cases that all writers on this subject give 
diet an Important place In treatment. Any treatise 
attempting to regulate the lives of patients or 
correct hygienic irregularities must consider the 
food Intake. Not a few heart patients are slaves 
to their appetites, and are devoted to certain 
viands which they call " good things,'' good 
enough, perhaps, in themselves, but bad for the 
consumer and some of which are entirely unfit 
for human food. Sometimes the appetite is so 
keen as to lead to abuse of the gastronomic powers 
and a daily indulgence of taste which overtaxes the 
physical capacity. To such a person the phy- 
sician's " do " and " don't " Is very unpopular. 
However this may be, every one who has an Indi- 
cation of gout or rheumatism, high blood pressure 
or hardening of the arteries, should make a study 
of his diet, and it is particularly for such persons 



66 WHAT HEART PATIENTS 

as show the early signs or symptoms of auto- 
intoxication that this chapter is written. 

How may excessive eating affect the heart and 
blood vessels? First, by causing an over-supply 
of nutriment in the system, surcharging the blood 
stream with toxic products, which effect or bring 
about an auto-intoxication of the entire system. 
This result is manifest particularly in the kidneys 
and blood vessels, the first indications being in- 
creased blood pressure and abnormal findings in 
the urine. The heart must increase its activity 
very much, In order to supply the enormous 
amount of blood to the stomach which the diges- 
tion of a ten-course dinner requires. 

All alimentary substances not required by the 
system, all those that cannot be assimilated and 
absorbed by the tissues, must be excreted princi- 
pally as waste matter. Imposing an excessive bur- 
den of work on the kidneys. These organs may 
stand the strain for some time, but sooner or 
later they are bound to break down under the ex- 
cessive strain, and too often when medical advice 
is sought, there has been already much damage 
done to the kidney substance. This condition so 
often produces, and is so often accompanied by, 
heart disease that many medical writers no longer 
term it '' Bright's Disease," but give it Instead the 



SHOULD KNOW AND DO 67 

very significant name of " cardio-vascular-renal 
disease." 

As I have said elsewhere, the system, in its 
effort to rid itself of this enormous waste mat- 
ter, maintains an excessive tension in the kidneys 
and blood vessels, which already gave rise to a 
high blood pressure. If an abnormally high blood 
pressure continues for any considerable time, a 
weakened heart is almost sure to be the result. 
Whether this condition is due to toxins absorbed 
from the intestines, or whether it is due to the 
toxins retained in the blood from insufficient ex- 
cretions of the kidneys, is a matter we leave with 
the pathologist, rather than to concern ourselves 
with it here. Let it suffice for us to know that 
there is an excessive amount of toxins present 
and that toxins are responsible for cardio-vas- 
cular diseases, and that evidence points to ex- 
cessive or irrational eating as inducing toxins in 
the system. 

The heavy eater may cause embarrassment to 
his heart, by overloading the stomach, which, in 
consequence, presses upward on the diaphragm 
and heart. Such a distended stomach may en- 
croach on the heart to such an extent as to cause 
serious interference with its normal function. 
Should the heart be weakened from former ex- 



68 WHAT HEART PATIENTS 

cesses or from other causes, such as acute illness 
or strain, an encroachment of the stomach on the 
weakened heart may produce serious damage or 
indeed may cause a sudden ending to a life which 
might otherwise, by proper precaution, be pro- 
longed for years. 

Overeating and capacious eating are increasing 
in proportion as nations grow in wealth, and are 
fast becoming serious physical sins of men, for be it 
said to the credit of the weaker sex that, as regards 
the former, they show strength of moderation. 
The heart is more or less disturbed by distention 
of the stomach, whether this distention be from 
too much food or from the formation or accumu- 
lation of gases. The heart and stomach are sep- 
arated only by a cross curtain, the diaphragm, 
which contracts and relaxes with respiration and 
upon which the heart rests. It is easily seen how 
the distended stomach pushing up the flexible par- 
tition, encroaches on the heart, producing disagree- 
able symptoms such as palpitation. The forma- 
tion or accumulation of undue gases is frequently 
relieved by a change in diet. Sometimes, how- 
ever, the flatulence has its source in nervousness. 
Whether an excess of air is taken in with the food 
or whether in disturbed respiration the patient 



SHOULD KNOW AND DO 69 

draws the air in, is a matter about which there 
is still discussion, but which does not particularly 
concern the patient until some means of preven- 
tion be offered. 

The food of all heart patients or patients suf- 
fering from cardio-vascular-renal disease should 
be taken regularly; three or more meals, no one 
of which should be decidedly heavy or with a long 
fast intervening. The demand of the tissues for 
nourishment is more or less constant during the 
fourteen or sixteen hours of mental or physical 
activity of the day, and it follows that should a 
long interval precede a heavy meal, the vessels 
drawn upon to supply the nutriment to the tissues 
and to supply also the natural and constant secre- 
tions of the body during the interval, become very 
much depleted. Should the patient at this time 
take a heavy meal, the vessels become surcharged 
with an enormous mass of pabulum, causing a 
sudden very high blood pressure. These wide 
variations in blood pressure and blood volume are 
likely to cause serious heart mischief. If such 
person have an impaired valve or the integrity 
of the heart muscle be below par, the impaired ap- 
paratus will with difficulty adjust itself to such 
extremes. Even though the person feel no dis- 
comfort after such indiscretion, serious harm to 



70 WHAT HEART PATIENTS 

an already impaired heart may eventually be 
caused by the sudden increased work imposed on 
this organ in the act of digestion. That every 
community has a tragic demonstration of this fact 
may be seen by consulting the reports in the daily 
newspapers — " Heart Failure After a Hearty 
Meal/* " After a Good Dinner," or " While the 
After-dinner Speeches Were Being Made." 

Certain articles of alimentation have high food 
value, and are easily digested, and yet, notwith- 
standing, or because of these two things, which 
in themselves are a recommendation, unduly fa- 
cilitate the absorption in the blood of an excess of 
nutrition products, overfeeding the cells, the or- 
gans and tissues, or better expressed perhaps, 
overtaxing them with pabulum which they cannot 
utilise, affecting sooner or later the blood vessels 
and the heart. 

The cardiac or vascular trouble, caused or ag- 
gravated by excessive nutritive substances in the 
blood, sometimes extending over a period of years, 
while in the majority of cases rightly attributed 
to overfeeding or overindulgence, is not infre- 
quently due to poor or faulty digestion and 
metabolism, as in the case of the moderate or 
spare eater, whose intake may be as much in 
excess of his need as is that of the former. 



SHOULD KNOW AND DO 71 

In either case, extra work Is required to disin- 
tegrate the nutritive pabulum and the removal of 
the waste of the bodily tissues Interfered with 
and delayed. This retention of the tissue waste, 
the result of absorption of nutrition products, not 
vicious In themselves, is very hurtful. If, however, 
the excess be the product of deleterious substances, 
bearing Injurious toxins. It Is apparent that the 
danger may be much greater. 

From the fact that animal flesh and eggs putrefy 
when they are taken In excess and are retained or 
delayed in the system after decomposition, many 
have gone to the extreme of banishing animal 
food from the diet, which my experience leads 
me to think is In many cases injudicious. It Is 
my custom to allow meat a few times a week, or 
once a day, or even oftener, according to the 
peculiarities of the person or case. While care 
must be taken that meat be given a less prominent 
place In the diet, there Is absolutely no reason for 
excluding It In amounts which the Individual can 
digest and use. Where the Individual Is already 
suffering from excess of animal products, from 
delayed retention, or from toxins. Infectious dis- 
ease or gout, all of which have a hurtful Influence 
on the blood vessels and heart, meat should be 
abstained from or much restricted for a time. 



72 WHAT HEART PATIENTS 

That carbohydrates do not putrefy, and are not, 
when retained, toxic in themselves, should not lead 
to the hasty conclusion that they may in every case 
be taken with greater safety or even with greater 
comfort. 

It should be borne In mind that processes, 
normal functions, when exaggerated, become 
morbid. 

Although carbohydrates, when unduly retained 
In the system, " simply ferment,'* which sounds 
very innocent, they may when badly used be the 
indirect cause of deleterious waste of the bodily 
tissues. When taken in excess or when re- 
tained long or when there Is abnormal digestion, 
this fermentation may be so great as to cause un- 
comfortable distention of the intestines and the 
stomach, and even harmful encroachment of the 
latter organ on the heart. Excess of non-putre- 
fiable, as well as putrefiable, food may overtax the 
system, producing Increased tissue waste and a 
train of disturbances. 

Altogether, the mixed diet seems the best one 
to keep up the strength and give the pleasure of 
variety, unless there be a positive contraindication. 
Care must be taken that the amount of food 
Intake be kept in proper proportion to the de- 
mands of the body, that there be no overloading 



SHOULD KNOW AND DO 73 

of the alimentary tract. On the other hand, It is 
important that the intake be sufficient to keep up 
the strength and nourish the tissues. Lack of suf- 
ficient food leads to inactivity and, in time, atrophy 
of the digestive glands, abnormal metabolism, and 
a weakening or derangement of one or more of 
the vital organs. It v^Ill be seen that the 
amount of food consumed is worthy of consid- 
eration, though not of such close and constant 
thought as to become a burden or to lead to mor- 
bidity. 

Food values are reckoned in calories, heat 
products, or, more properly, energy products, the 
normal person requiring about 2,500 calories, less 
or more, in proportion to his muscular activity, 
his habits and personal peculiarities. For those 
whose exercise is restricted, It is more likely to be 
less than more. 

" A small portion of the food eaten is utilised 
by the body for the building and repair of tissue 
and the performance of physiological functions In 
general, but by far the larger part of the food is 
used as a source of energy for the performance 
of muscular work, both internal and external, and 
it Is commonly stated also for maintaining body 
temperature. There is reason to believe, how- 



74 WHAT HEART PATIENTS 

ever, that within ordinary temperature limits, at 
least, the body maintains this temperature by 
utilising heat resulting as a by-product from the 
performance of muscular work. The main func- 
tion of the food, then, is to enable the body to 
perform muscular work. 

" The source of the power obtained from an 
engine is the fuel burned under its boiler, and 
in the same way the source of the energy which 
the body uses for work of all sorts is found in 
the food consumed. The theoretical energy- 
values of all ordinary food materials have been 
determined by laboratory methods which are sim- 
ilar to those used for determining the theoretical 
energy-values of coal and other sorts of fuel. 
Only a part of the energy of the fuel burned 
under a boiler is available for mechanical work, 
the efficiency of an engine being dependent upon 
the kind of fuel used, the principles of construc- 
tion followed in building the engine, and other 
factors. The problem of determining the ef- 
ficiency of an engine — that is, how much of the 
theoretical energy of the fuel is available for 
mechanical work — is a matter of great importance. 
It is equally interesting to ascertain the efficiency 
of the living engine — the body — and to ascertain 
the extent to which it converts the energy of food 



SHOULD KNOW AND DO 75 

into effective muscular work. This problem has 
been studied with the respiration calorimeter and 
important data have been secured. . . . While 
there were some differences in individuals (with 
respect to this factor) the agreement in all cases 
was sufficient to warrant the assumption that the 
efficiency of the average man performing muscular 
work is at least 20 per cent. 

'' In this respect, man compares very favoura- 
bly with the best steam engine. It is safe to say 
that the average efficiency of these does not ex- 
ceed 14 per cent. Some types of Internal com- 
bustion engines develop an efficiency of more than 
double that, but they are at present exceptions. 
Moreover, In the case of the steam engine, there 
appears to be a certain rate of work at which It 
will develop its greatest efficiency, but in the case 
of man it was shown that with one subject at least 
an increase in the load did not materially affect the 
efficiency of the body as a machine. Under all 
conditions of work, it was found with this subject 
that about 21 per cent of increased heat produc- 
tion due to muscular work was represented by 
the heat equivalent of the muscular work per- 
formed. 

*' To state the matter in another way, these 
figures mean that for every calorie of work the 



76 WHAT HEART PATIENTS 

body performs it must be supplied with 5 calories 
in its food." * 

Physiologists, after making extensive experi- 
mental studies on a great number of individuals, 
have fixed approximate standards for the actual 
needs of the human body. Most of these ob- 
servers agree that the average individual is well 
fed on about 60 grams of protein foods, such as 
meats, eggs, etc., ^6 grams of fats, and about 
500 grams of carbohydrates, such as sugar and 
starches. As I have said elsewhere, the mission 
of the family physician, as a guardian of the 
family health, is to prevent illness in the family. 
For this reason, he should acquaint himself, as far 
as possible, with the habits and food tolerance 
of the individuals and with the tendencies and 
peculiarities of the family. This knowledge is 
helpful in prescribing a diet in health that will not 
overtax the digestive organs, causing disease, and 
that he may prescribe a diet in illness of sufficient 
calories to sustain the body strength. Nutritive 
equilibrium is the relation of the amount of nutri- 
ment required by the body and the amount of 
actual nutriment ingested with the food. If the 
body requires 120 grams protein and the food 

* Langworthy and Milner, Yearbook, Department of Agri- 
culture, 1910. 



SHOULD KNOW AND DO 77 

ingested contain 200 grams of protein, the ellm- 
Inative organs are overtaxed with 80 grams of 
protein of which they must rid themselves as waste 
material, since the tissues of the body cannot as- 
similate this surplus or use it in the tissue-change 
which is constantly going on in the body. 

The average man or woman who has a house 
can tell without hesitation about how much fuel 
is required daily for the furnace, and will know the 
effects of over-economy of fuel and of over-firing. 
We should think a person a very stupid motorist 
who did not acquaint himself with the kind and 
average quantity of oil required to run his auto- 
mobile, that he might know the efficiency of the 
machine and not so far miscalculate his supply as 
to be stranded repeatedly in the country. Yet 
these same persons, well informed on questions of 
the day, are not infrequently totally ignorant and 
often uninterested in the amount and nature of 
the fuel needed for the engines which furnish the 
power in their own bodies. If man gave half the 
care and thought to the machinery of his body that 
he does to the " beautiful car " of which he is 
the proud possessor, he would be likely to run a 
good long course without a breakdown. 

Roughly estimated, the following kinds and 
amounts of food yield 100 calories : 



Yield 

100 

calories 



78 WHAT HEART PATIENTS 

1 egg 

2 oz. of meat 
I oz. of cheese (American) 
1^ cupful of milk ; i]4, cupful of skimmed milk 
I large orange 
6 lumps sugar 
I pat, nearly % oz. butter 
I good-sized potato 
I large slice bread 
I large slice toast 
Rice, cooked, 2 tablespoonfuls 
400 cupfuls of beef tea, more or less, enough 

to drown a patient 

The Council on Pharmacy and Chemistry of 
the American Medical Association have done ex- 
cellent and impartial work in their analyses of so- 
called food preparations, particularly the class 
containing large percentages of alcohol. They 
have shown that some of the very popular ones 
are absolutely worthless as food equivalents, aside 
from the amount of alcohol, which may make them 
hurtful. Some of the magazines have done valua- 
ble work in this line, with the advantage over the 
medical journals of being able to reach the public 
directly. A careful observer at the University of 
Pennsylvania, who made some tests with dry pro- 
prietary foods, reports that one of these, for 
which fabulous nourishing claims were made, is 
so light in weight and poor in food value that the 
consumer must ingest a dollar twenty-five to one 
dollar fifty cents' worth to get the equivalent of 
a five-cent loaf of bread. Another investigator 



SHOULD KNOW AND DO 79 

writes: ''Their use In health would result In a 
polite form of starvation." 

The market Is glutted with catchy and euphoni- 
ously named baby foods. Two of the best known 
and popular of these, when tested, were found 
so poor In nourishment that any child depending 
on them entirely would suffer from malnutrition. 
The test of a New York physician shows that the 
quantity advertised as a meal for a slx-n^onths-old 
child Is equal In food value to two ounces of good 
milk. Meat extracts, meat juices, and meat 
broths have enjoyed a confidence from the medical 
profession and the public In general which they 
have never deserved. One physiologist. In con- 
demning meat extracts, says: "They are a de- 
lusl'on and a snare." 

As a rule, persons suffering from heart trouble 
should have a nutritious diet, that no energy of the 
weakened digestion be expended on foods which 
do not add nourishment to the tissues. Their diet 
should be digestible, that no energy be wasted 
and no gases formed to press against the weak- 
ened heart and cause further embarrassment to 
that organ. It is a mistake for the patient to 
depend on a liquid or semi-liquid diet, thus elim- 
inating mastication. 

In fact, most nutritious foods which agree with 



8o WHAT HEART PATIENTS 

the patient may be taken, for keeping up the 
bodily strength is a most essential feature in the 
case of persons with heart or blood-vessel 
troubles. With advancing years, fortunately, the 
appetite is no longer as keen as in early adoles- 
cence. At this stage of life we do not require so 
much food, as there is less physical and mental 
activity, hence the tissues do not require so much 
nutriment as in the more active period of life. 
It is often a source of grievous regret to elderly 
persons who once enjoyed an excellent appetite 
that they no longer have the keen relish for a 
good dinner. 

Trouble of another form, commonly called 
*' heartburn," may prove a serious annoyance to 
persons suffering from weak heart. This trouble 
is not in the heart. It is a form of in- 
digestion, due to the excessive secretion of the 
juices of the stomach, of the hydrochloric 
acid, and is known as hyperacidity, or hyper- 
chloridity. This distressing condition is often 
counteracted by a bit of cooking soda in a 
cup of hot water, which neutralises the hydro- 
chloric acid in the stomach. Another simple 
method of stopping this trouble is to take a rasher 
or two of bacon for breakfast. The bacon, it 
is claimed, retards the flow of gastric juice, thus 



SHOULD KNOW AND DO 8i 

stopping the excess of hydrochloric acid, by slow- 
ing the process of digestion. Olive oil also is 
very effective in most cases, but the fat bacon has 
the advantage of being a palatable food. The 
bacon should not be too lean, too salty, nor too 
much grilled or fried. The first scientific observa- 
tions in the use of bacon in cases of heartburn 
were reported by the celebrated German special- 
ist. Professor Ewald, of Berlin. 

Moderation in all things should be a strict rule 
of life for persons suffering from heart trouble. 
In the matter of diet it is difficult to give definite 
restrictions. One person may require little food, 
while another with vigorous appetite may be very 
uncomfortable and badly nourished on the same 
restrictions. Persons suffering from heart trouble 
are often the victims of dietetic fads and ex- 
tremes which work serious harm. It is folly for 
an old person whose arteries have already under- 
gone the hardening process to deprive himself 
entirely of meat if he crave it. It is pathetic to 
see an old man hungering on a purely vegetable 
diet, when meat once a day would keep up his 
strength and satisfy his desire, while the total 
abstinence from meat at his advanced age makes 
no material difference in his heart or arteries. 

The^ following suggestions are given to guide 



82 WHAT HEART PATIENTS 

persons suffering from heart and arterial trouble 
in the choice or regulation of their diet. As a rule 
the diet should be varied and a mixed one for 
the best vigour of mind and body, unless contra- 
indicated. 

Relishes before meals are apt to excite an un- 
natural appetite. 

Soups. — Cream soups, cereal or vegetable, are 
allowable, unless they destroy appetite for solid 
food, or the liquids are restricted. Meat extracts 
and broths are to be avoided, as they have very 
little nutritive value, and are made chiefly of the 
hurtful properties of the animal tissues, namely 
the nitrogenous extractives. As the majority of 
persons suffer from an excess of extractives in 
the system, it is obvious that meat broths, which 
afford only temporary stimulation, should be 
avoided. 

Fish. — Fresh fish may be taken in moderation; 
oysters are good, preferably raw; salmon and 
mackerel, which are fat and rich, are often indi- 
gestible. Lobster and crabs had better be avoided. 
Salt and smoked fish partaken of sparingly, if at 
all. 

Meat and poultry, as well as fish, may be taken 
by most persons once a day. Fat bacon is al- 
lowable from time to time and beneficial where 



SHOULD KNOW AND DO 83 

there Is heartburn or hyperacidity. Sometimes 
it is necessary to restrict the animal food intake to 
once a week, or to exclude It altogether for a 
period. Where the arteries show high tension, 
the following articles are to be avoided: Liver, 
kidneys, caviar, sausages, smoked meats and 
gravies. If a low meat diet or meat-free diet is 
associated with Increased fermentation In the 
stomach or Intestines, the gases causing discom- 
fort, lightly but well-cooked meat should be taken 
oftener, as It Is easily digested and In many cases 
is necessary to give the proper food balance. 
Boiled meats are preferable to those prepared in 
other ways, because the nitrogenous properties 
are largely extracted. 

Eggs, which are exceedingly nutritious animal 
food and easily digestible, raw more easily than 
cooked, are Indicated where there Is Impaired 
nutrition. They, however, when unduly retained, 
sometimes give trouble from gases and distention, 
especially when taken late in the evening. 

Cereal foods are recommended when well 
cooked. Bread, wheaten, rye or brown, should 
be well baked and twenty-four hours old, or 
toasted for variety, palatabllity and digestibility. 
Deficiency in fat is made up by butter. 

The new " breakfast foods " are good as far 



84 WHAT HEART PATIENTS 

as they go, which for some of them is a short 
way, since they are very light. Oatmeal and rice, 
as in fact all the cereals, should be thoroughly 
cooked. Many persons show an intolerance for 
buckwheat. It should be born in mind that the 
individual has his idiosyncrasies and proclivities; 
he may show an intolerance for certain recom- 
mended foods or he may thrive on others thought 
to be indigestible. Since cereals supply sugar for 
intestinal digestion, they should be eaten without 
addition of sugar. Butter or cream may be added. 

Cereals being free from purin * elements are 
indicated where nitrogenous diet is restricted. 
Their chief disadvantage, when prepared as soft 
foods, is that oral digestion or mastication being 
dispensed with, the stomach or intestines may be 
overburdened with the bulk; they are too easily 
digested to keep the digestive organs in good 
working order when depended upon entirely. 
Predigested foods are indicated only where the 
digestion is much impaired, and if depended on 
too long, weaken the digestion. 

Green vegetables, thoroughly cooked and well 
masticated, are important constituents of diet. 

* Purin, a carbon-nitrogen nucleus occurring in many- 
products of tissue change, purin bodies originating in the 
system during metabolic processes or being derived from 
purin bodies of foodstuffs. 



SHOULD KNOW AND DO 85 

iThough very nearly all of them may be taken, 
especially the fresh, tender ones, the resistant 
capsule of beans and peas should be well broken 
before going Into the stomach. Spinach and 
tomatoes sometimes promote hyperacidity, in 
which cases they are to be avoided. Mushrooms 
should be abstained from. 

Vegetables are laxative food. Potatoes are al- 
lowable, better old than new. 

Raw vegetable salads should be partaken of 
sparingly. Salads of fruits or of cooked vegeta- 
bles, with olive oil and a little lemon juice instead 
of vinegar, are preferable. 

Fruits. — Most of the fresh fruits may be taken 
when well ripened. Bananas should be very ripe, 
that the starch be changed to sugar. Some per- 
sons show an intolerance for blackberries, straw- 
berries, gooseberries or grape fruit, which is very 
acid. Although the current view is that the acids 
of vegetables and fruits do not contribute to an 
acid condition in the system, an intolerance, espe- 
cially for the fruits mentioned, is manifested by 
a number of persons. Stewed fruits, without 
skins and seeds, are good. Fruits, like vegetables, 
are laxative, preventing constipation. 

Honey is admissible. Melons are harmless if 
very ripe. 



86 WHAT HEART PATIENTS 

Cheese is a good substitute for meat and eggs, 
and better for some persons, in that it is a 
non-putrefiable proteid. It should form the chief 
course of a meal instead of following a big dinner, 
and avoided altogether if inducing constipation. 

Sweets and pastry should be partaken of spar- 
ingly. Saccharine has not the food value of sugar, 
but should be used when the latter is not well 
borne. 

Spices and pepper, in fact all condiments, should 
be avoided. Very small amounts of salt retard 
digestion, assimilation and nutrition, giving rise 
to deleterious substances in the blood. 

Individuality plays an important part in diet, 
even for those who are well. " What is one man's 
meat is another's poison." Some who read this 
book will be able to eat anything and everything 
as long as moderation is practised. Others will 
find that they do not bear well some of the foods 
advised. Where there is lack of appetite there is 
something wrong, not always directly physical, 
but due perhaps to sorrow, worry, excitement or 
fatigue affecting the organism. Where the ap- 
petite is capricious, it may have to be coaxed, but 
artificial excitants, such as relishes and wine, 
should be resorted to with caution. It is unfor- 
tunate for a woman who is not well to have to 



SHOULD KNOW AND DO 87 

oversee the preparation of food, as she is apt to 
lose her appetite before going to the table. Food 
should be palatably prepared and served in an 
appetising way. 

Nuts. — Most of the edible nuts are poor In 
starch and sugar and rich In protelds and oils, 
some kinds yielding more than 50 per cent of 
the latter. Nuts are concentrated nutriment, 
yielding a high per cent of energy. It is obvious 
that, like cheese, they should not follow a full 
meal, after sufficient food has already been taken, 
though they may well constitute a definite part of 
the meal, unless oils and protelds are contralndi- 
cated. They are not indigestible when well mas- 
ticated, and taken In proper amounts, unless the 
digestive powers are weakened or deranged. It 
is an advantage to have to pick the nuts out of 
the shells at the table, as there Is thus less danger 
of overburdening the digestive organs with sur- 
plus. Chestnuts, unlike most of the other edible 
nuts, are starchy or carbohydrate, having com- 
paratively low per cent of proteld and oils. 
When cooked or baked, they form In some coun- 
tries an Important article of food, taking the place 
of bread and potatoes. 

Some persons do exceedingly well on a diet in 
which nuts are the principal article. In fact, a 



88 WHAT HEART PATIENTS 

diet of nuts, bread, vegetables, grains and fruits 
is recommended for some persons complaining of 
dizziness. 

Mastication. — The importance of mastication 
of food and oral digestion promoting the assimila- 
tion and nutriment cannot be too much em- 
phasised. Recent investigation shows that many 
of the foods which have been deemed very indi- 
gestible, are digestible if properly chewed. 
Poorly chewed foods overtax the stomach and in- 
testines. Not only are the fibres of meats and the 
capsules of vegetables broken up by mastication, 
and thus more easily acted upon in the stomach 
and intestine, but the chewing influences the flow 
of the digestive juices. One well-known English 
authority on the heart makes the patient's ability 
to chew the index for giving solid food. Counting 
the number of times every mouthful is chewed, 
while valuable as giving emphasis to the impor- 
tance of mastication, makes eating too laborious, 
whereas it should be a pleasure. 

The amount of food should be in proportion 
to the exercise. If the activities are restricted, as 
they are for many of my readers, the diet should 
be curtailed accordingly. To " cut diet, cut 
work," should be added: cut work, cut diet. Age 
must also be considered in the regulation of diet. 



SHOULD KNOW AND DO 89 

The youth needs food for growth and develop- 
ment, as well as for sustenance, and is likely to be 
more active than an adult. The adult needs only 
enough food to maintain his body, the supply not 
exceeding the waste. 

Radical changes in the diet of old people are 
usually unadvisable. That is, taking away all 
meats from a person who is accustomed to them, 
or making a sudden reduction in the amount of 
food, as with age there is likely to be a low- 
ered vitality and diminished resistance already 
existing. 

Liquids. — Pure water is the best thing to quench 
the thirst, and there is less danger of taking too 
much liquid, as is apt to be done when the drink 
has a pleasant taste or flavour. 

Milk, called by various writers " a model 
food," " a complete food " or " a perfect food," 
seems to be all of these for the person who is 
suffering from an attack of cardiac exhaustion, 
who has been put to bed and whose digestive or- 
gans must for a time be spared as much as possi- 
ble. How long it answers the needs of the body, 
and in what quantity it is to be taken, are matters 
to be determined for the individual by the attend- 
ing physician. 

Notwithstanding that, theoretically, milk Is a 



90 WHAT HEART PATIENTS 

perfect food, having all the essential properties for 
nourishment in fair proportion, Its proteld being 
non-putrefiable. Its carbohydrates non-fermenta- 
ble, Its freedom from purlns. Its easily digested 
fats, which show it worthy of an important place 
in diet; as a rigid exclusive diet, it is not held as 
meeting perfectly the needs of the majority of 
persons for any length of time. About a gallon 
a day would be necessary to supply the tissues with 
adequate nutriment. Such an excess of fluid is not 
admissible in most cases, aside from the unwise 
exclusion of mastication and of the benefits of solid 
foods where they are well borne. Milk, however, 
is an important article of food, and especially for 
those who have heart trouble. The marked in- 
tolerance for milk which some persons show may 
be overcome by diluting the milk with some 
slightly charged water, or by decreasing the rich- 
ness of the milk by skimming off part or all of the 
cream. In an acute attack of gout, a diet of bread 
and milk often promotes relief. 

Coffee. — The worst thing about coffee is that It 
keeps the consumer from knowing when he Is tired 
and when he is sleepy; it stimulates the fatigued 
brain and muscles to go on and demands from the 
heart undue exertion. It stands to reason that 
the heart which beats faster and oftener than the 



SHOULD KNOW AND DO 91 

normal rate, which has not sufficient time to re- 
cover Itself, will eventually suffer weakness or 
exhaustion. The reserve force of the heart Is 
thus often heavily drawn upon before the Indi- 
vidual Is aware or before he seeks advice. If 
he continue to use coffee after It Is forbidden, he 
only cheats himself. 

It is coffee as a beverage which is here consid- 
ered, not as a medicinal drug, which should be 
prescribed when Indicated. Coffee Is classed as a 
toxin; It Is apparent that it should find no place In 
the diet of one who Is already suffering from toxic 
poison. 

It is only when coffee is used in excess that the 
primary cause of toxic poison is traced to Its use. 
Where, however, there is already toxic poison 
from infectious disease, from digestive or assim- 
ilative disturbance, the semi-daily or daily coffee 
Is apt to be harmful, while chronic or acute poison 
from excessive indulgence Is followed by morbid 
and not infrequently grave symptoms. 

Functional heart troubles, the nervousness mani- 
fested In trembling, palpitation, etc., not uncom- 
monly disappear with the discontinuance of coffee. 
It should be borne In mind that, while a cup of 
weak coffee Is not as harmful as a cup of strong 
coffee, two cups of the former may be equally or 



92 WHAT HEART PATIENTS 

more hurtful than the latter, according to the total 
of hurtful properties ingested. 

The dilution of coffee with milk and cream, 
which seems the least hurtful to the majority of 
persons, induces an attack of indigestion in some, 
who consequently must take it clear, if at all. 

As to the oft repeated questions regarding the 
caffeine-free coffees now on the market, as to 
whether the caffeine has actually been removed 
and whether the beverage may be taken with im- 
punity, I can but say that the caffeine is extracted 
to a minimum or inappreciable amount, that the 
beverage is far less exciting, but that as long as 
coffee is coffee it will retain harmful properties. 
If coffee is not to be entirely excluded, the next 
best thing is to have it in the least hurtful form. 

A recent German writer calls attention to the 
fact that hot coffee is more likely to cause disturb- 
ance of the digestion and heart than cold coffee; 
that anaemic persons are known to bear cold coffee, 
where hot coffee produces an uncomfortable effect 
which is apparently due to the greater activity 
and escape of the volatile oil in the hot beverage. 
He thinks that the old German saying, " Kalter 
Kaffee macht schon " — " Cold coffee makes one 
beautiful " — has a great deal of truth in it. At 
least it does not seem to produce the bad com- 



SHOULD KNOW AND DO 93 

plexlon and ill looks of the dyspeptics, who are 
accustomed to taking their coffee hot. The same 
writer claims that his tests indicate that when the 
accumulation of fat and of waste particles is thor- 
roughly removed from the green beans by Immer- 
sion In water at 150° or 160° Fahrenheit, and a 
process of brushing followed by ten minutes dry- 
ing before roasting, that coffee becomes much less 
likely to give rise to disagreeable symptoms. He 
thinks that many of the heart disturbances held 
accountable for indigestion are, in all probability, 
the result rather than the cause of the trouble. 
After dinner there is a natural bodily relaxation, 
facilitating digestion and conserving circulation, 
which should not be fought off or counteracted by 
coffee. Coffee tends to prevent constipation, and 
hence its use In moderation may be permitted, 
where there is trouble of that kind. That coffee 
and caffeine are considered valuable medicinal 
drugs has nothing to do with the question of 
coffee as a beverage. Strychnine and morphine 
have also therapeutic value, but it does not follow 
that they are to be taken daily or at any time not 
Indicated by some abnormal bodily condition. 
Tea, like coffee, has a direct as well as Indirect 
effect on the heart. It is also, like coffee, toxic. 
[Tea-poisoning is much more common in England 



94 WHAT HEART PATIENTS 

than in America or Germany, where coffee Is held 
in greater favour. Tea, too, is the morning bev- 
erage, taken often on an empty stomach, quickly 
absorbed and poisoning the tissues. Like coffee, 
it contains caffeine, but, unlike coffee, it has a tend- 
ency to constipate and may start a train of ills 
in this way, acting and reacting on all the vital 
organs and the nerves. Tea not uncommonly 
causes flatulence and distention. Tea, when al- 
lowable, should not be permitted to stand on the 
leaves more than three minutes before it is used, 
otherwise the tannic acid may have to be reckoned 
with. Many persons become so dependent on the 
accustomed coffee or tea in the morning that, if 
deprived entirely of such beverage, they lose their 
appetite for food and begin the day badly 
equipped. In such cases it may seem best to per- 
mit the morning cup. 

Water at Meals. — Although recent tests show 
that water at meals, when not taken to wash down 
food, tends rather to promote than disturb the 
digestion of normal persons; those who have 
heart trouble will do well to drink in moderation. 
As to the taking of fluids generally there can be 
no hard or fast rule, for each person is more or 
less a law unto himself, and the intake of fluids 
in each particular case must be regulated accord- 



SHOULD KNOW AND DO 95 

Ing to the conditions present. Highly charged 
waters at the table should be sparingly Indulged 
in, if at all, for the reason that the gases may 
distend the stomach and cause pressure on the 
weakened heart. On the other hand, they some- 
times aid digestion and prevent formation of 
gases In the stomach. If plain water is taken at 
the table the quantity should not exceed ten 
ounces. Where there is any digestive trouble, no 
fluids should be taken at the table or for about 
an hour after the meal. Drinking-water should 
not be ice-cold. 

Alcohol. — It is my custom, and that of most 
practitioners to-day, to interdict all alcoholic 
drinks for such very good reason as that given by 
Sir John Broadbent In his treatise on the heart in 
speaking of alcoholic drinks : " Their effects as 
excitants of the heart may, to some extent, be neu- 
tralised by the relaxation of the peripheral vessels 
which they Induce, but their general tendency is to 
interfere with due metabolism and elimination and 
to bring about degeneration of structure." The 
drinking of any kind of alcoholics, where there 
is heart or blood-vessel disease, should be pro- 
hibited. It is only when such stimulant is indi- 
cated that alcohol Is permissible, and in many of 
these cases I have found other stimulants more 



96 WHAT HEART PATIENTS 

active and reliable and hence to be preferred to 
alcohol. The physiological reason for here ad- 
vising against the use of alcohol is, that, although 
the whiskies, brandies and spirits contain almost 
no purins, they, even in small amounts, inhibit 
purln metabolism, while beer, ale, porter and stout 
all contain purins and should, therefore, not be 
used by persons already suffering from auto- 
intoxication. In a great many cases the begin- 
nings and the aggravation of arterlo-sclerosis are 
ascribed to habitual alcohol. Alcohol, acting di- 
rectly on the heart, Is a frequent source of heart 
Irritability and nervousness. The excessive use of 
alcohol tends to an increase of bodily weight, with 
overtaxing of heart and often encroachment on 
that organ. 

Vegetarianism is, and must obviously always 
remain, a question of individual taste. Numerous 
experts show that universal vegetarianism under 
our present conditions is not feasible. The ques- 
tion whether the earth Is capable of producing suf- 
ficient vegetable albumen to supply the human fam- 
ily may be left to the statistician. All proteid 
substances, whether animal or vegetable, must In 
the process of metabolism in the body be broken 
up, forming new compounds before they can enter 
Into or form part of the body tissues. As the 



SHOULD KNOW AND DO 97 

body tissues show no selective affinity for the com- 
pounds derived from animal or vegetable protelds, 
reasoning chemically, the body should be as well 
nourished with a vegetable diet as with an animal 
diet. Reasoning practically, this Is also true for 
at least some persons. As the heart or blood 
vessels have no direct connection with the sesthetlc 
tastes of their host, whether It Is the thought of 
the slaughtered animal that prevents his enjoying 
a porterhouse or the " national bird " on Thanks- 
giving, matters little to these organs. If the nutri- 
tive elements are sufficient and In proper relative 
proportion for the construction of the body tissues, 
these organs will perform their normal physio- 
logical function, regardless of whether the nutri- 
ent elements be derived from animal or vegetable 
sources. These elements are broken up Into 
amino-acid and form the " building stones '' for 
the body tissues. The principal substances form- 
ing the food of man are made up of protelds, 
fats and carbohydrates, and the relative proper 
proportions are best obtained by the judicious use 
of a mixed diet composed of vegetables, fruits and 
meats. 

Meats are rich In protein substances, widely 
blamed for the purin bodies and most of the 
deleterious or poisonous elements found In condi- 



98 WHAT HEART PATIENTS 

tlons of auto-intoxication, in gout, in rheuma- 
tism and in most cases of arterio-sclerosis. For 
this reason the meats are somewhat, or much, re- 
stricted in the diet. For the same reason meats 
are often restricted in perfectly healthy persons, 
who have large appetites; for in satisfying these 
appetites they consume a quantity of meat which 
furnishes an over-supply of proteins, manufactur- 
ing in the system poisons almost sure to bring 
about diseased conditions. Physicians find that 
many persons do not do well on a vegetarian diet. 
The most logical claim thus far made for a vege- 
tarian diet is that it fills the stomach and satisfies 
the craving of hunger without introducing an ex- 
cess of nutrient substances into the system. Vege- 
table foods are poor in fats and comparatively 
poor in proteins, their carbohydrates enclosed in 
more or less insoluble cellulose envelopes which 
are only partially digested or assimilated In the 
human alimentary canal. This furnishes the phys- 
iological reasons for a vegetable diet being often 
prescribed in cases of obesity, when such condi- 
tion is accompanied by — as is often the case — a 
very vigorous appetite. The majority of cases 
of obesity are due to malassimilation, and as such 
should be treated by correcting the diet. The 
first effort in this direction is to reduce the amount 



SHOULD KNOW AND DO 99 

of fats in meats, gravies, soups, sauces, butter, 
cream, etc. If meats are admitted In the diet of 
such a person they should be very lean and only 
a small portion once a day, preferably at the mid- 
day meal. 

To take up the special diets In specific diseases 
of heart or blood vessels Is nqt my purpose. In- 
deed It would not be within the province of a work 
of this kind. There are, however, some general 
dietary rules that should be observed, particularly 
In rheumatism, gout, hardening of the arteries 
and auto-intoxicatlon, troubles which are concom- 
itant with heart trouble. The first and most Im- 
perative dietary rule Is moderation. The hearty 
meal at or about midday at which meat may be 
eaten, the choice of beef, poultry, mutton, veal, 
etc., may be left to the taste. Often It Is necessary 
for patients suffering from the above troubles to 
be prohibited all meats, — that an absolutely meat- 
free diet be adopted. Gout and rheumatism are 
variable diseases, each presenting Idiosyncrasies 
that call for special attention, the treatment In all 
these cases requiring Indlvlduallsation. As the 
question of diet In the treatment of these troubles 
Is of paramount Importance, I will mention a few 
of the articles which should be strictly forbidden : 
sweetbreads, kidneys, liver, beefsteak, venison, 



100 WHAT HEART PATIENTS 

jam, meat extracts, pickled and canned meats. 
Boiled meats are better than meats roasted or 
grilled, the boiling removing much of the toxic 
substances contained in the meat fibre. In general, 
the purin-free foods are milk, cheese, cream, 
butter, eggs, bread, fruits, vegetables with the ex- 
ception of beans, oatmeal, peas and pea meal and 
asparagus. 

Recent experiments in Germany show what a 
vast economy may be expected in the near future 
in the upkeep of the body nourishment. The 
conditions now arising all over the world, in- 
creasing the cost of living by leaps and bounds, 
will naturally interest social economists in these 
experiments. Indeed it is surprising, with all this 
human cry of high cost of living, that we have 
neglected this subject so long. When we consider 
what a large per cent of the income of the masses 
IS expended in upkeep of the body and what a tre- 
mendous waste is found in this item of expenditure, 
it gives one the feeling that here is a vast field 
for practical missionary work. These experi- 
ments not only point to vast possibilities in mone- 
tary economy, but also by synthesis have shown 
that the animal tissues may be fully nourished at a 
much less expense of wear and tear to the di- 
gestive organs in the process of metabolism. 



SHOULD KNOW AND DO loi 

The two factors controlling the weekly or daily 
diet of most families are the weekly allowance 
and personal taste. Families with modest incomes 
will indulge in the most wanton extravagance in 
the matter of food, not particularly In buying the 
most expensive delicacies, but In selecting foods 
which appeal to the taste, many of which have al- 
most no nutrient value. A thrifty housewife who 
will with the greatest assiduity study the efficiency 
and durability relative to the economic value of 
every staple commodity that enters her household, 
will make no effort to learn the caloric values of 
the food she purchases for her family. She is 
governed in her selections by the taste of the dif- 
ferent members of the family, or by the price of 
the article in question, and congratulates herself 
on being very particular when she insists on the 
meats, cereals, fruits, and vegetables, which she 
chooses, being fresh and free from decay. These 
are superficial attributes, as compared with the 
real unit of efficiency, which can only be estimated 
by the allowance of gross waste for each food 
and the net nutrient value, or units of calories, 
received for the money invested. Dietetic econom- 
ics for practical purposes is not a difficult study, 
one of which indeed the average housewife may 
get a comprehensive knowledge in a short time. 



102 WHAT PATIENTS SHOULD DO 

In the very near future, every city and town, 
it is hoped, will have a pure food society organ- 
ised by the best people of the community for the 
determination of having better and purer food for 
their families. They will not only demand full 
legal weights and measurements, but will force 
tradesmen to give some evidence of the quality 
and nutrient value of their purchases. By very 
little study, every mother or head of a household 
may learn the nutrient value of the food she may 
select for her day's menu. The nutrition experts 
in the government laboratories at Washington are 
constantly issuing scientific reports on this subject, 
which may be had for the asking. They are also 
ready and willing to give gratis expert advice on 
the calories or nutritive value of all of the foods 
in everyday use. With the co-operation of the 
local physicians, which I am sure would be easily 
obtained, as would also the local press, such a 
society would be of inestimable value to every com- 
munity, in providing families much more econom- 
ically with better and purer foods, those which 
yield energy, health and greater usefulness. 



BODILY WASTE 

Whenever there Is retention of bodily waste, 
whenever the elimination of waste Is out of normal 
proportion to the intake, great varieties of 
troubles affecting the heart and arteries, directly 
or indirectly, arise. First to be considered Is con- 
stipation, so closely associated with poisons In the 
blood. Constipation Is Induced by sedentary hab- 
its, while daily exercise favours the emptying of 
the bowels. Irregularity in going to the closet in- 
duces retention, while the establishment of regu- 
larity tends to overcome It. The diet should be 
mixed with a preponderance of laxative foods, 
such as vegetables, ripe fruits, stewed fruits, with 
a variety of breads, brown and white, coarse and 
fine, while strong tea, chocolate, cocoa, fresh 
breads, unripe bananas should be avoided by one 
who already has an accumulation of poisons in his 
system. Straining at the stool is hurtful. Morning 
tea on an empty stomach is to be avoided. Some 
hot or cool water, slowly sipped, Is beneficial. 
Creams, sour milk, are commended. Exposure to 
cold and wet, Improper clothing, sleeping In 111- 

103 



I04 WHAT PATIENTS SHOULD DO 

ventilated rooms, insufficient or Injudicious bath- 
ing induce or favour constipation. The skin, the 
kidneys and the lungs, also outlets of the body- 
waste, should be given favourable conditions to 
enable them to perform adequately their func- 
tions. Massage and proper baths often give re- 
lief from habitual constipation and promote bodily 
elimination. Thick milk, buttermilk, the various 
Metchnikoff lactics, such as Yoghurt, are also 
endorsed as giving relief from constipation and 
counteracting the bacterial poisons. It should be 
remembered, however, that these milks have great 
food value, and If added to an already liberal 
diet may give an excess of food. 



BATHS 

Baths, as commonly considered in relation to the 
well-being of man, are for cleansing purposes, or 
for therapeutic purposes, or for both. As the 
first, they are essential to the health of the Indi- 
vidual; as the second, they are valuable agents. 
The physician who has made careful study of the 
action of baths in health and In disease, who has 
observed their effects on hundreds or even thou- 
sands of patients; who knows, from his own ex- 
perience or from the writings of scientific investi- 
gators, that baths, plain or mineral, hot or cold, 
have a remarkable effect for good or ill, will warn 
the patient against indiscriminate bathing for 
cleansing purposes, and doubly warn him In pre- 
scribing for himself a course of medicinal baths, 
or of taking such a course at any time without 
the supervision of a physician. Persons who 
would not think of taking a course of drugs with- 
out advice, take a course of baths, quite as potent 
measures for good or ill, entirely unaware of the 
great risk they run. My opinion is that a great 
many normal persons reduce their vitality by mis- 
takes In their cleansing baths, and I am perfectly 

105 



io6 WHAT HEART PATIENTS 

sure that many who have diseases of the heart 
or arteries do themselves positive harm. In the 
absence of advice, for the person whose vitaHty 
is much reduced or whose symptoms are of a 
serious nature, the sponge bath, with quick appli- 
cation of a warm towel, seems the safest cleansing 
method. If, however, the bath Is to be taken 
in the tub. It should be borne In mind that the 
depth of the water and the temperature of the 
bath are of great Importance. The half bath, 
reaching to the waist-line, the three-quarter bath 
to the nipple-line, the full bath, covering the entire 
thorax, having different degrees of influence on 
the body, the half bath the least, the full bath the 
most, while the safest range of temperature is 
between 92° and 94° Fahrenheit — that of the 
tepid bath. Any modification of temperature 
above or below this range becomes, for the indi- 
vidual who has heart trouble, either a therapeutic 
bath, which ought to be prescribed In view of a 
certain diseased condition, or a dangerous risk. 
The duration of the cleansing plain water bath 
should not be more than two or three minutes, the 
temperature of the room ranging never more than 
a few degrees from that of the bath, the body 
dried without delay. 

As in the majority of cases the peripheral 



SHOULD KNOW AND DO 107 

capillaries are congested, the elimination of waste 
matter through the skin sluggish, It is very im- 
portant that the skin be kept clean and as vigorous 
as possible. 

It should be clearly understood that the cold 
bath Is of service In only very special conditions. 
Many persons do themselves great harm by tak- 
ing cold baths entirely unsuitable or positively 
contraindicated by their condition. The cold bath 
constricts temporarily the blood vessels, slows the 
heart's action, raises the blood pressure and causes 
additional work for the heart In consequence of 
the additional force It must use to overcome the 
extra resistance In the constricted blood vessels. 
Generally speaking, persons with high blood- 
pressure symptoms should avoid cold baths and 
those suffering from kidney disturbance should do 
likewise. Patients with weak heart should not 
indulge In cold baths on account of the sudden 
extra work put upon the heart by the abrupt in- 
creased resistance of the constricted vessels, which 
the heart must overcome for sufficient blood to 
reach the different tissues of the body. No one 
should take cold baths who does not react well 
after them. Cold baths, if permitted, should be 
immediately followed by a brisk rub with a rather 
coarse towel, and, better, a coarse hot towel. 



io8 WHAT HEART PATIENTS 

A bath with a temperature of 95° Fahrenheit 
and upward is considered a warm bath. The 
action of this bath is to dilate the skin capillaries, 
the peripheral vessels, reduce blood pressure, 
quicken the pulse rate; it reHeves the work of the 
heart by lessening the resistance against which 
the heart must pump the blood to the organs of 
the body. The tepid bath is considered the neu- 
tral zone of temperature at which the body re- 
ceives neither the physiological action of heat or 
cold, which in a plain water bath is 92° to 94° 
Fahrenheit. This is the safest bath for cleans- 
ing purposes, as it has a minimum action on the 
heart and blood vessels and is more cleansing than 
the cold bath. Since marked action on the heart 
and blood vessels is produced by cold or hot baths, 
it is apparent that irreparable harm may be done 
where they are not judiciously regulated and in- 
dicated by careful medical examinations. Baths 
should not be taken when the stomach is full or 
during active process of digestion. This is an 
imperative rule, particularly with the cold bath. 
This same rule pertains to the administration of 
the douche bath as well, and should be a warning 
to those taking a cold douche while the body is 
warm, as after exercise. 

Sea bathing is very refreshing and stimulating, 



SHOULD KNOW AND DO 109 

the salt, the constant motion of the waters and 
temperature all adding to the stimulating effect 
of this form of bath. The activity of this bath 
Is such that It should not be taken by the Indi- 
vidual before he has had the assurance that there 
Is" nothing In his physical condition which con- 
tralndlcates such stimulation. 

Another general rule regarding baths is that 
after any bath one should rest for at least 
a few minutes. If the bath be tepid or 
cold he should rest (better In the recumbent posi- 
tion) long enough for the system to recover 
from the stimulation, the time of rest being 
in proportion to the stimulation. After a warm 
bath the rest should be longer, as the capillaries 
of the skin, being extremely dilated, require 
longer to recover their equilibrium, and this Is 
particularly true If the surrounding atmosphere 
be cold, as naturally the greater the contrast 
the greater the danger of bad results. The 
warm bath Is very relaxing, and for this reason 
the cold douche Is sometimes recommended Im- 
mediately following a warm bath. For the person 
who Is below normal, or for the fairly normal one, 
who does not react well. It had better be avoided, 
unless advised. The sea salt added to the plain 
water bath at home affords an extra stimulus to 



no WHAT HEART PATIENTS 

the system that Is often very beneficial where such 
stimulation is needed. 

The Turkish and Russian baths are entirely 
too vigorous for four-fifths of those who take 
them and should never be taken without medical 
advice. Notwithstanding my great faith In baths 
as a valuable therapeutic measure, particularly 
for affections of the heart and blood vessels, I 
should not think It safe to give general directions 
to the laity, or to recommend such treatment in- 
discriminately. Many people look upon water 
as harmless or neutral. Plain water. Internally 
or externally applied, may be beneficial, may be 
neutral or hurtful, according to temperature, 
quantity and the condition of the subject. When 
the question Is one of mineral water the range of 
potency for good or evil Is greatly Increased. 

The carbonic acid brine bath has become a 
well-recognised treatment In almost all kinds of 
chronic heart and blood-vessel diseases. This 
form of bath has a direct action on the 
heart and blood vessels. It has a stimulating 
effect on all the glands of the body, therefore 
increasing elimination of toxins from the system, 
improving In many cases blood pressure, relieving 
the weakened heart and quieting the nerves. Car- 
bonic acid saline baths offer a hope in heart dis- 



SHOULD KNOW AND DO 1 1 1 

eases and rheumatism when other measures are 
useless. The carbonic acid bath tends to stimu- 
late all the organs of elimination, particularly the 
liver, either directly or by relieving the conges- 
tion which prevents the organs from performing 
their functions normally, the increased elimination 
producing a beneficial effect either directly or in- 
directly on the heart, for in most instances there 
is a damming up in the system of the waste or 
poisonous products from lack of elimination. 
Plain baths will have this action to a certain ex- 
tent, but the effect is only transitory, while the 
action of the carbonic acid baths is in most cases 
more constant and very much more permanent. 



SLEEP 

Sleeplessness Is often concurrent with heart 
trouble, sometimes as a consequence of the latter, 
but as often as a forerunner of the same. The 
very worry, sorrow, overwork or overstimulation 
which produced the Insomnia may have been, and 
continue to be, an Important causal factor of the 
disturbed circulation or cardiac insufficiency. Al- 
though the heart Is active throughout the night, 
a time of rest for mind and body Is necessary 
for the building up of the tissues, even of the 
tissues of the heart Itself; for the repair of waste 
of the body, and of the wear and tear of the day. 
It Is easily seen how Important it Is that all the 
conditions for sleep be made as favourable as 
possible, especially for the person whose heart 
Is obliged to do extra work. In order to keep up 
the circulation sufficiently to nourish the body, 
and, In addition, perhaps, make compensation for 
some defect brought about by previous overstrain, 
Infectious disease or other cause. 

The first and many times the Impossible thing 
to do is to exclude cares and worries from the 

112 



WHAT PATIENTS SHOULD DO 113 

chamber at bedtime. The patient and those about 
him, however, should remember Its Importance 
and make every effort In that direction. With 
some men and women It has become a habit to 
plan, after they go to bed, their work or social 
engagements for the next day. The lawyer thinks 
out his speech; the business man reviews the trans- 
actions of the day or speculates on those of the 
morrow, while his wife anticipates or reviews her 
domestic cares, or plans her social entertainments 
or thinks too Intently about her paper at the club. 
Wakefulness brought about by this procedure can 
and ought to be stopped, by proper effort. 

The mind at bedtime should be kept as passive 
as possible. Every exciting thought should be 
banished, hence the efficacy of the popular pre- 
scription of counting sheep jumping over a fence 
or the more monotonous recitation of the alpha- 
bet. The husband and wife who have had a com- 
mon sorrow or living sorrow are very likely to 
fall into the reminiscent brooding mood at bed- 
time. Let me ask the one who Is well to help the 
other to dwell on cheerful but not exciting sub- 
jects at the close of the day. 

Active brain work should be given up an hour 
before bedtime, even If It be but the reading of 
a book of essays or history which requires con- 



114 WHAT HEART PATIENTS 

stant concentration, attention and thought. Ex- 
citing stories late in the day should be avoided; 
also games of cards which over-excite or require 
close attention. Some light, pleasant reading, 
neither taxing nor exciting, may prove beneficial. 

Regularity in going to bed, in doing all he can 
to form the habit of sleep, becomes a cardinal 
virtue for the person whose heart is affected. 
Too much importance cannot be given to exer- 
cise, air and light, all conducive to sleep. Exercise 
should not be indulged in to excess or to the 
point of fatigue. Over-fatigue or active exer- 
cise late in the day is likely to produce wakeful- 
ness. Sunlight in the daytime, though not in ex- 
cess, is good for the body and the mind, dispelling 
gloomy thoughts and depressing apprehensions. 
Fresh air at night, as well as in the daytime, should 
be provided, avoiding a direct current over the 
bed. 

There should be a thermometer in every bed- 
room, especially when the occupant is not in a 
normal state of health. The patient should be 
warm enough for comfort, whether he sleep out- 
doors or in, as his sleep will otherwise be restless. 
Needless to say, the bed should be good, long 
enough, wide enough and just that degree of 
hardness or softness which the individual may 



SHOULD KNOW AND DO 115 

iprefer. Special conditions may indicate that the 
head should be higher or lower than custom, af- 
fording more comfort and facilitating the heart 
action, or that the centre of circulative pressure 
be changed by raising slightly the foot of the bed, 
thus counteracting a condition of sleeplessness, as 
is sometimes determined by the individual himself. 
His pillow should be right, the size he likes, with 
the proper degree of softness, by which I mean 
the kind of pillow he finds comfortable, not one 
with special soporific qualities, like that of King 
George the Third, which was filled with freshly 
dried hops, claimed to have special virtue for the 
uneasy head of him who wore a crown. It 
scarcely seems necessary to say that the heart 
patient should have a bed to himself, as should 
every one, whether well or ill. The matter of 
bedclothes should be looked after, that they be 
sufficient, but not too many or too heavy. Many 
men, especially those living in hotels, get into beds 
just as they are, without a thought about what 
may be the proper amount of covering for the 
temperature of the room, the climate or their own 
peculiar needs. The covers should be well tucked 
in, that they may not slip from the bed and thus 
disturb the rest of the person who in reaching for 
them all night, gets up In the morning tired and 



ii6 WHAT HEART PATIENTS 

perhaps cold. Very often wakefulness is caused 
or exaggerated by some such simple thing. 

Insomnia is often traced to late dinners or over- 
eating. Not infrequently, however, it is due to 
hunger or lack of assimilation. Such persons find 
that a bite of something to eat before going to 
bed or a biscuit in the night, or a little milk, if 
it be not excluded from the diet, is conducive to 
sleep. 

Coffee, tea, alcohol, smoking must be abstained 
from in the evening, if not at all times, by the 
person who suffers from disturbance of the heart, 
as I have said elsewhere. The man who does not 
believe this, who thinks his habitual cup of coffee 
or his cigar after dinner has nothing to do with 
his wakefulness, because he does not lie awake 
every night after such indulgence, has only to try 
drinking the second cup of coffee, or to smoke an 
extra cigar in the evening, to have a long wretched 
night in which to meditate over his folly. 

Nervous persons, or those who become easily 
fatigued, should sleep a half-hour in the after- 
noon. My experience has been that, instead of 
interfering with the patient's sleep at night, the 
afternoon siesta is conducive to his better rest. 

Whatever else he does, he should not take 
sleeping powders or sleeping potions of his own 



SHOULD KNOW AND DO 117 

accord. The taking of them is attended with too 
much risk, especially where the heart Is not nor- 
mal. The physician may find that for a particular 
case the sleeping drops are less harmful than the 
wakeful nights, but the physician is the one who 
must decide in such cases and watch that the pa- 
tient does not grow to depend upon them. 

The patient who has his emergency prescription 
renewed for months or years afterwards, does 
not cheat his physician half as much as he does 
himself. 

Persons with different temperaments and dif- 
ferent conditions of health require varying 
amounts of sleep. There is not much danger of 
overindulgence in sleep for the adult person who 
suffers from heart disease, or from disease of the 
blood vessels, the difficulty in the majority of cases 
being to overcome undue wakefulness. In most 
instances, the practice of " early to bed and early 
to rise " gives the best promise of health, if not 
of wealth and wisdom. 



HABIT 

Habit, Instead of being what the Latin derivation 
implies: action or condition which the individual 
has or which he has a tendency toward, is often 
an action or condition which has the individual. 
Habit is more than second nature — it is, as some 
one has so well said: "ten times nature." Al- 
though habits, generally speaking, include virtues, 
as well as vices, we will concern ourselves here 
only with those hurtful to man and most potent 
in causing or aggravating heart trouble. Of the 
insidious habits which seriously affect the heart 
and blood vessels, the use of tobacco Is by far the 
most frequent and dangerous. It is the most fre- 
quent and dangerous because it Is a habit formed 
in early youth when the tissues of the developing 
boy are in a transitory stage, needing all the 
vitality possible for the building-up process. It is 
then the youth Is most susceptible to Intoxication, 
for tobacco, as well as whisky, intoxicates. Much 
damage is likely to be done to the muscular fibre, 
to the heart wall and vessel walls of the youth 
who uses tobacco. I am satisfied that the in- 
sidious nicotine plays an Important role in the 

Ii8 



WHAT PATIENTS SHOULD DO 119 

premature degenerative changes found In early 
adolescence and in middle life. 

Some patients show a total disregard for ad- 
vice, refusing to be convinced of the harmful 
nature of their habits. They are not will- 
ing to accept the judgment and experience of 
men who make a study of the causes and effects 
of disease. They remind me of a certain German 
servant girl, who, having spilt gasoline on her 
clothing, was warned by her mistress not to go 
near an open fire, and told of the inflammable, 
combustible nature of gasoline and the danger in- 
volved. The girl, on whose face a very Incredu- 
lous expression played, disappeared from the 
room, as her mistress supposed, to change her 
dress. In a few minutes, however, she returned 
with a triumphant look, to say that she had put 
fuel on the kitchen fire, having proved thus to her 
own satisfaction, since she had neither taken 
fire nor blown up, that her mistress was mistaken 
about gasoline's dangerous properties. 

The discontinuance of tobacco, unless too much 
damage has already been done, will make a fa- 
vourable change in the blood pressure and lead 
to a disappearance of palpitation and other an- 
noying symptoms. Where the Impairment of the 
heart Is from other causes, the Individual, be he 



120 WHAT HEART PATIENTS 

young or old, will aggravate his trouble and be 
likely to suffer from intense irritability of the 
heart, if he persist in the indulgence of tobacco. 

To our women let me say, before it is too late : 
*' Would that you might see in the health resorts 
of Europe the hundreds of women, habitual 
smokers, who come from the countries where such 
is the custom, struggling to free themselves from 
the habit, seeking health which they sacrificed so 
thoughtlessly! " 

Every physician recognises the great advantage 
possessed by the person who has never been a 
victim to vitiating habits when such a one is called 
on to meet a physical crisis, such as an operation 
or when he is seized with penumonia, typhoid or 
any of the very debilitating acute diseases. 

If the patient has never indulged in habits 
which keep the system below the normal point 
of resistant force, there is a good mark in his 
favour for the chances of withstanding the severe 
strain put on the system. 

It is said that we should all die from tubercu- 
losis if we did not possess within us a resistant 
force sufficient to overcome the infection to which 
we are all at some time in life exposed. 

Why then dissipate this force which may be 
needed any day? 



SHOULD KNOW AND DO 121 

The Oriental who pays the physician to keep 
the family well and stops his salary when sickness 
invades the household, is not to be laughed at. 
The medical profession of the civilised countries 
to-day stands for preventive medicine. 

The American Medical Association sends out 
lecturers to educate the people and to solicit 
the co-operation of the public in the prevention 
of disease. This does not free the individual 
physician, who is a member of the association, 
from his duty to his patients and the community 
in which he lives. Neither has he discharged his 
whole duty when he destroys disease-producing 
germs or prevents their inoculation. He should 
use his influence and employ every rational means 
to prevent the younger generation from forming 
habits which will surely weaken or destroy their 
natural resistance to disease. Parents are largely 
responsible for the promiscuous tea and coffee 
habit in youths. 

A growing child needs no stimulant further 
than good, nutritious food, and when such an 
active stimulant carrying as much poison as either 
of the above is allowed, it is capable of doing 
positive harm. Parents who would shudder at 
the thought of their children's drinking whiskey, 
will pour coffee and tea into their stomachs in 



122 WHAT HEART PATIENTS 

quantities sufficient to overstimulate and spoil the 
digestion of any child. 

Among the English, who are addicted to strong 
tea, tea poisoning with disturbed heart function 
is very common, while in Germany and America 
the bad effects of coffee are much more general. 
In Germany, especially among the students, the 
impaired hearts are often due to beer, the constant 
or excessive use of which poisons the blood and 
diminishes the power of the heart to carry on its 
function. 

Every one knows among his acquaintances or 
friends men or women who have freely indulged 
In these beverages for years, without any apparent 
harm to health, but these persons are the exception 
rather than the rule, and no proof that the habit- 
ual use of these beverages is not hurtful. 

The misuse of alcoholic beverages Is a very 
potent cause of diseases of the heart and blood 
vessels. It is a well-recognised fact that the per- 
nicious habit of taking whiskey highballs and 
nightcaps has doomed many an otherwise strong 
man to premature heart failure. Alcohol In any 
form Is an active heart stimulant, and should be 
used only under the direct order of the physician. 
It is an irritant to the vascular walls and increases 
the hypertension In the blood vessels. By this 



SHOULD KNOW AND DO 123 

increase of tension In the vessels and by Its stim- 
ulating toxic products, It very frequently causes 
Bright's disease or Interstitial nephritis. Alcohol 
also causes changes In the liver which, sooner or 
later, produce a diseased liver, known as hobnail 
liver, or tippler's liver. 

The heart specialist Is constantly meeting these 
pathological conditions In these two organs, as a 
result of changes In the blood vessels supplying 
them. Any one doubting the soundness or urgency 
of this doctrine need only turn to medical books 
on heart diseases to see what an Important place 
the first authorities give to Intoxicating drinks as 
the cause of cardio-vascular diseases. 

The evil results of the habit of bolting food 
and of overeating are discussed in another 
chapter. 



THE HEART AND CIRCULATION 

To the reader who has been patient or interested 
enough to read the preceding pages, I am ready 
to confess some stratagem or design in having 
placed this chapter here instead of at the begin- 
ning of the book, where it would seem to belong. 
It was because I feared the reader would never 
go farther than the first chapter, or perhaps the 
first paragraph, recalling his schooldays and the 
dead bones of anatomy, the perplexities of physi- 
ology which he had to crawl over or seek his 
way through, arriving at hygiene in too exhausted 
or in too dulled a state of mind to take any interest 
in " How not to get tired " and " How to keep 
well and strong." The person who writes for the 
public is reluctant to use the terms '^ anatomy " 
and '' physiology," fearing that his book will be 
abruptly closed. Hence it is that I have endeav- 
oured to remove the stumbling blocks from the 
doorway of the unnamed Hygiene, that her sug- 
gestions for the preservation and restoration of 
health may seem less difficult to obtain. 

124 



WHAT PATIENTS SHOULD DO 125 

Many of my readers, engrossed In the current 
affairs of life for many years, have forgotten 
much of their physiology, particularly that part 
which pertains to the heart and blood vessels. 
That the reader may the more easily understand 
the pathological conditions, the disordered func- 
tions mentioned in the subsequent chapters, it is 
essential that careful thought be given this chapter 
on the physiology of the heart and blood vessels, 
that a fair understanding of the normal functions 
be had in dealing with the variations from the 
normal. 

Circulation of the blood Is a metaphorical 
phrase, and means that the blood, so long as it 
remains In the vessels, moves along a tortuous path 
in a definite direction and returns to a given point. 
Should we now follow a certain particle of blood, 
we find it leaving the heart during the contraction, 
entering the great vessels, aorta or pulmonary 
vessels, which soon divide and subdivide, until the 
collective dimension of their lumen far exceeds 
the size of the vessels leaving the heart. Conse- 
quently we find the blood current correspondingly 
slower. As the blood path widens, naturally the 
speed of the current Is slower. The blood corpus- 
cle passes out Into the smaller vessels, Into the 
very small arteries, thence Into the capillaries, and 



126 WHAT HEART PATIENTS 

it is in the capillaries that all the functions of the 
blood are performed. It is here the blood reaches 
the ultimate tissues, to supply them with the nutri- 
ment brought from the alimentary canal. By the 
process known as chemical affinity, the tissues are 
able to extract from the blood stream in the capil- 
laries through their extremely thin membranous 
walls all the elements necessary to their main- 
tenance, and give off the waste matter which they 
can no longer use. This interchange is called 
osmosis, and is the essential act in the process of 
assimilation. The building up or construction of 
tissue, is known as anabolism; the tearing down, 
or destruction, is known as katabolism, both 
processes constituting metabolism, a physiologi- 
cal function, in constant progress in all animal 
tissue. 

The blood is usually called the nutritive fluid 
of the body. Its functions may be more explicitly 
stated as follows: It carries to the tissues food- 
stuffs after they have been properly prepared by 
the digestive organs; it transports to the tissues 
oxygen absorbed from the air in the lungs; it 
carries off from the tissues waste products formed 
from the processes of disassimilation; it is the 
medium for the transmission of the internal secre- 
tions of certain glands, and it aids in equalising 



SHOULD KNOW AND DO 127 

the temperature and water contents of the body. 
The blood of the body is contained in a practically 
closed system of tubes, the blood vessels, and is 
kept moving always In a definite direction, and 
never In the reverse, by the forces of the heart's 
contraction. To a study of these elastic tubes let 
us now turn. 

The heart is a muscle, a hollow organ com- 
prising four compartments, with a partition run- 
ning up and down in the middle, dividing the organ 
into right and left hearts, practically making two 
distinct organs which work in unison. The right 
heart and the left heart are again divided into 
two chambers, the upper and lower, the upper 
cavity called an auricle, from Its resemblance to 
a dog's ear; the lower cavity called the ventricle, 
the real pump that forces the blood out into the 
arteries, the capillaries and veins. The auricle 
acts as a receptacle for receiving the blood from 
the veins, and retains it, until the ventricle is 
ready to receive it. Between the auricle and the 
ventricle there are little flaps of tissue, called 
valves, which act to close up the aperture between 
the two chambers. These valves are called the 
auricular-ventricular valves. These valves are an- 
chored by very fine but very strong tendons, which 
enable them to open and close with rhythmical 



128 WHAT HEART PATIENTS 

precision, each time the heart beats. The func- 
tion of these valves is to guard the opening from 
the auricle into the ventricle, and prevent the 
blood from returning into the auricle from the 
ventricle when the ventricle contracts. The mus- 
cular walls of the ventricle are very thick and 
firm and have great power. The force exerted at 
each contraction must naturally be very great to 
drive the blood out into the most distant parts of 
the body and into the smallest vessels. It is 
obvious that at each forceful contraction of the 
ventricles there is a powerful pressure against 
these valves, the strain of which, under normal 
conditions, or within physiological conditions, 
they are able to withstand. If there occurs an 
inflammation of these valves, the frequent result 
is a slight contraction, a thickening or shortening 
of the valves, which prevents their coming com- 
pletely together, and in consequence the blood 
returns into the auricle at each contraction of the 
ventricle. This condition is spoken of as a 
" leaky valve," or " leaky heart," or valvular in- 
sufficiency, or valvular stenosis. A leaky heart 
may also come from other causes, which will be 
considered later on. 

The auricle has a double function ; it is a reser- 
voir for the blood, and by its contraction assists 



SHOULD KNOW AND DO 129 

In charging the ventricle with blood. These con- 
tractions are called systoles, and the auricular 
systole Is necessarily followed after a very slight 
pause by the ventricular systole. These systoles 
make up the heart beat, and each heart beat 
causes the pulse wave felt at the radial or wrist 
artery. The ventricles, as we have seen, are the 
two lower chambers of the right and left heart 
and are the real pumping apparatus of the 
heart. The left ventricle Is close to the chest wall, 
the base being almost In the median line of the 
breast bone, pointing downward and outward to- 
ward the left arm, the apex almost In con- 
tact with the chest wall, on a line with and 
just below the nipple in the fourth Intercostal 
space. 

The right ventricle Is to the right and behind 
the left ventricle and presents very little surface 
to the chest wall. The contractions, or systoles, of 
the two ventricles are synchronous, the right forc- 
ing the blood Into the lungs, to be aerated or oxy- 
genated, while the left ventricle pumps the blood 
Into all the other parts of the body; hence this is 
called the systemic circulation, while the right ven- 
tricle pumps into the pulmonary circulation. The 
systemic circulation being Infinitely greater, taking 
In, as it does, the entire anatomy, furnishing blood 



I30 WHAT HEART PATIENTS 

to the ultimate tissues of the body, must naturally 
have a much greater pumping force behind it than 
is found in the pulmonary system. Thus the left 
ventricular wall is found very thick and firm, 
oftentimes two or three times thicker than the 
walls of the right ventricle. 

In estimating the work done by the heart In 
maintaining the circulation, we must depend on 
the uncertain though important quantity of pulse 
volume and upon the force with which each ven- 
tricle ejects the pulse volume, or blood wave. A 
small fraction of this force is expended in impart- 
ing a certain velocity to the ejected blood, the 
rest serving to overcome a number of opposing 
forces which we shall study under " blood pres- 
sure." 

It is not necessary for our purpose to describe 
all the events that occur In the cardiac cycle, or 
all the events that go to make up the heart beat; 
sufficient for us is to know of the " period of 
reception of blood," when the valves between the 
auricles and ventricles are open and the ventricles 
are filling, and the " period of ejection," when 
the auriculo-ventricular valves are closed and the 
pulmonary valves are open, which is the ventricu- 
lar systole when the blood Is forced out of the 
heart Into the arteries, constituting what is known 



SHOULD KNOW AND DO 131 

as the systole, or heart beat. As soon as the ven- 
tricles have emptied themselves, the walls relax, 
constituting the diastole, with its period of rest 
for the muscular walls of the ventricles, and it is 
in this way alone, between each beat, that the 
heart takes the only rest it ever gets. One real- 
ises the importance of the diastole when he learns 
that this is the only rest the muscles of the heart 
get during life. Hence, the diastole Is called the 
compensatory pause, for it is during that short 
Interval, or pause, that the muscle tissue must ac- 
quire the energy for the succeeding systole or 
beat. 

To understand the physiological function of the 
arteries, it is first necessary to get some idea of 
their anatomical structure. Arteries have In gen- 
eral three coats, made up of muscular fibres, 
elastic tissue and the internal coat made up of 
serous tissue. This combination admits of 
strength and resiliency, necessary for the proper 
function of the vessels. 

We see, from the anatomy of the blood vessels, 
that they are so constructed as to favour the work 
of the heart in maintaining the circulation. In fa- 
cilitating the work of the heart, the elastic fibres 
of the vessels play an important role. Any con- 
dition which diminishes the resiliency of the vessel 



132 WHAT PATIENTS SHOULD DO 

wall naturally causes a disturbance In the fine ad- 
justment of the circulation between the heart and 
vessels, in consequence of which the work of the 
heart is very much increased, or the ordinary work 
becomes out of proportion to its already much 
exhausted power. 



BLOOD PRESSURE 

Blood pressure, as the term Implies, Is the pres- 
sure of the flowing blood In the blood vessels, 
maintained, to a normal or abnormal standard, 
by the pumping of the heart, by the quality of 
the blood and by the condition and elastic response 
of the tubes through which it passes ; — the former 
when the three essential factors are normal, ab- 
normal when one, two or all of the three factors 
are deficient, unless such deficiency of the one be 
counteracted or compensated by another. As long 
as the circulation Is kept up, there Is pressure of 
some kind. It is only when It rises above the 
normal or falls below the same that it Is a matter 
deserving attention. A deviation from normal 
blood pressure either Indicates something wrong 
or that It is the natural consequence of age. 
Which it Is and to what it Is due should, If possible, 
be ascertained. It should be borne in mind that 
high blood pressure or low blood pressure Is no 
more a disease than Is a pain, but like pain it 
Is a manifestation or result of some derangement. 
When the warning bell of high blood pressure 
133 



134 WHAT HEART PATIENTS 

is heard the pedestrian had better stand still until 
the fast train goes by. Many a foolish fellow 
has lost his " precious minutes " with his life in 
trying to rush across the track after the sounding 
of the danger signal. In many instances all that 
is necessary is for the individual to stand still for 
a few moments of his life or to slacken his pace 
for a while, in order that he may go on for years 
at a good ordinary rate. 

The deviation from the normal blood pressure 
is an important symptom in diagnosis. The ob- 
ject in treatment is not to reduce or eradicate the 
symptoms, but to ascertain and attack the cause. 
Many times, especially if the abnormal pressure 
be of long standing, it is unadvisable to make any 
but a very gradual change in the resistance or ac- 
customed pressure. If there are poisons in the 
system from bacterial diseases, from faulty diet, 
poor assimilation or from insufficient elimination, 
judicious measures should be employed to correct 
the condition. The capillaries and arteries con- 
tract to protect themselves and the tissues from 
poisons in the blood. Not only is the work 
of the vessels thus increased, but the heart has 
a greater resistant force to overcome, to send 
nourishment to the tissues. 

Chilling of the skin or exposure to sudden cold 




SHOULD KNOW AND DO 135 

congesting the peripheral capillaries, changes the 
resistance, at least temporarily, aggravating or 
causing a change In pressure. If there be any 
thickening or clogging of the pipes, the heart again 
tries to adjust itself to the deviation, and a change 
of pressure may be detected. 

The heart Itself may be embarrassed by an ill- 
nourished or dilated muscle, by a strain or defect, 
which also may make a difference In Its pumping 
force. Excitement, high tension, worry and sor- 
row, unfortunately In many cases not to be eradi- 
cated, exercise a powerful nervous influence on the 
organs, overworking or depressing them in their 
activities. 

The individual should know that his high or 
low blood pressure is a sign of some circulatory 
disturbance, that it may point to a trivial devia- 
tion from the normal or to a serious condition. 
In any case he should get the best possible In- 
terpretation of the sign, and plan his course of 
life or treatment accordingly. If it be unneces- 
sary to circumscribe his activities to any great 
degree, he should know It, that he may not 
abandon his profession or business without good 
cause. Again, a person who is accustomed to 
an active life is apt to brood and do himself 
great harm if he give up all his business or social 



136 WHAT PATIENTS SHOULD DO 

interests, which should enter into the reckoning 
of radical changes. Moderation in everything 
may be all that is required. Sometimes, however, 
it is absolutely necessary that the individual drop 
everything for a time, and his outlook and fu- 
ture activities depend entirely on his so doing. 
Here again comes the importance of seeking and 
following medical advice. 



ARTERIO-SCLEROSIS, OR HARDENING 
OF THE ARTERIES 

Hardening of the arteries, the term familiar to 
the laity for arterlo-sclerosis, is very misleading 
and terrifying to some minds. Many accept the 
verdict of the physician's diagnosis as a hopeless 
sentence. They are worried and depressed, fancy- 
ing that their blood vessels are turning to stone, 
petrifying slowly or rapidly, and that nothing can 
save them from this awful fate. In consequence, 
they brood, curb their activity to an unreasonable 
degree, and promote thereby the morbid or ab- 
normal condition already existing. Others, be- 
lieving their condition to be hopeless, try to for- 
get, by plunging with renewed effort into business 
or society, by drinking or smoking, excesses which 
may in the beginning have induced the trouble, 
and which are sure to be promoting agents. 

Still others are such slaves to habit, to business 
or society as to show a strange recklessness or 
indifference to their health, or inability to under- 
stand the import or gravity of their condition 
or of their heedless attitude. Bearing in mind 

137 



138 WHAT HEART PATIENTS 

these different types of persons, with all the Inter- 
mediate variations, who consult the heart spe- 
cialist, I fully understand how difficult, if not im- 
possible, it is to give the individual a proper view 
of his trouble and to win his willingness to regu- 
late his mode of life, so as to give him a fair 
chance of living his full number of years. " Hard- 
ened " arteries, having usually a high tension, 
with increased blood pressure, are taut and cord- 
like rather than hard or rigid like a tube. 

The arteries may be thickened temporarily or 
permanently, or they may be unduly contracted, 
without degeneration of the arterial coats or with- 
out calcareous Infiltration, which is found In ex- 
treme cases, and not infrequently in the arteries 
of men who make their living by hard manual 
labour, such as miners, blacksmiths, or men who 
shovel, dig or hammer all day long. 

" In my experience it is rare one finds In the 
well-to-do class calcareous changes In the vascular 
walls. These patients seldom have the brittle, 
calcareous arteries such as. In my clinical work In 
Berlin, I have found among the hand workers. 
We must recognise two forms of arterial degen- 
eration; the first, and by far the most prevalent, 
among the well-to-do class of society, many of 
whom have a very highly developed nervous or- 



SHOULD KNOW AND DO 139 

ganisatlon, brought on by strenuous living, and a 
seeming Inability to relax. These are the hyper- 
tension cases, and though we may find a fibrous 
degenerative thickening of the vascular walls, we 
seldom find a calcareous, brittle artery." * 

While the normal elasticity of the vessels is 
likely to suffer diminution. It Is most commonly 
not so reduced as to be unaffected by sane living 
and treatment. Hence the importance of heeding 
the early and blessed signals of warning, of re- 
moving as far as possible all causal or aggravat- 
ing agents, before degeneration with its grave se- 
quences takes place. The majority of patients have 
a favourable outlook if they are able or willing to 
follow advice and change their mode of life. 

Thickened arteries, of such common occurrence, 
especially in men, are not necessarily permanently 
thickened, as various medical observers testify, 
while most sclerosed arteries retain a measure of 
elasticity. While no course of treatment will re- 
store degenerated vessels, the strain upon them 
may be so diminished as to enable them to do 
their work, if the general constitution is good. 

While an abnormal condition of the arteries 

*" Carbonic Acid Baths in Treatment of Chronic Heart 
Diseases," by James Henry Honan, Southern Medical Jour- 
nal, April, 191 1. 



I40 WHAT HEART PATIENTS 

seems, in many Instances, directly traceable to tox- 
ins In the blood, there Is a long list of Inducing 
conditions directly or Indirectly associated or 
causal, comprising typhoid, Influenza, kidney dis- 
ease, venereal disease, tonsilitis, a diseased con- 
dition of teeth or gums, lead or paint poison- 
ing, gout, errors in diet, imperfect metabolism 
and elimination, over-exertion, prolonged strain 
physical or mental, Irregular living, stress, 
sleeplessness, anxiety and worry, indulgence 
in alcohol, coffee, tea, tobacco, over some or 
many of which the individual himself has more 
or less control, the favourable or unfavourable 
forecast depending more upon himself than he Is 
wont to believe. At least, in justice to himself, he 
should review the list, dwelling with serious 
thought upon every item, before dismissing It as 
something which concerns only 'the physician. 

Where the direct cause Is the evident outcome 
of excesses, overwork. Injurious habits, no time 
should be lost In making corrections. Where it 
is still existing, as In an infectious or chronic dis- 
ease, measures must be taken to combat the pri- 
mary cause. 

To many of my readers these diseases constitute 
a part of their past history, and It Is the conse- 
quences and harmful and adverse influences rather 



SHOULD KNOW AND DO 141 

than the primary causes which must be considered. 
Whether the causes are evident or obscure, pres- 
ent or past, it is important that the individual 
adopt measures which alleviate or check the ab- 
normal processes, instead of those which cause 
or aggravate. 

I. The bodily intake and waste are of great 
importance, not infrequently the direct or indirect 
cause of the toxins or deleterious substances in 
the blood, causing the tightening up and thicken- 
ing of the arteries or permanent changes in 
the same. The patient must eat and drink in 
moderation, though the diet may be liberal and 
varied. His diet should be simple and nourish- 
ing, meats being more or less restricted, while 
high game and all meat broths should be entirely 
prohibited. 

Alcohol, coffee, tea and tobacco must be listed 
as harmful. 

Constipation, with the retention and reabsorp- 
tion of poisons by the system, is dangerous. Con- 
stipation may be more easily avoided or controlled 
by the individual than he is wont to think. It may 
be due entirely to his irregularity in going to the 
closet, to his effort to read the news of the world 
while there, to his haste or impatience, to errors 
in food or to lack of exercise. 



142 WHAT HEART PATIENTS 

No day should pass without an active move- 
ment of the bowels. Not only Is the retention 
of waste matter hurtful, but the Incidental strain- 
ing at the stool increases the blood pressure and 
taxes the heart and arteries. Natural measures 
against constipation are preferable to artificial, 
though it is sometimes necessary to employ the 
latter for a while or periodically. Too frequent 
dependence on such means is to be avoided, as It 
is easy to acquire the pink, blue or some other 
coloured pill habit, of weakening the natural ex- 
cretory powers by the habitual taking of physic 
or by daily irrigation. 

Proper food, drink, exercise and regularity, if 
carefully attended to, will in most cases keep the 
bowels In good condition. Overeating Is un- 
doubtedly a common and serious factor. ^' One 
of the worst cases of arterlo-sclerosis I have seen 
was that of a man aged forty, whose vessels, 
heart and kidneys were all gravely involved, and 
whose condition was the direct outcome of his 
occupation. He was for years on board a large 
liner, and it had been his duty to taste all the 
dishes of the various dinners before they were 
distributed to the passengers and the crew." * 

* "Some Aspects of the Senile Heart, " by Dr. John Hay, 
Liverpool, Eng. 



SHOULD KNOW AND DO 143 

Moderation In all things should become his watch- 
word. His exercise should be taken without ex- 
ertion, his hours of activity should not encroach 
upon those for rest. Overwork and overplay must 
be avoided by the one whose blood vessels are 
affected. Great mental strain, excitement, pro- 
longed effort leave their marks on the arteries, as 
do all excesses, overeating, overdrinking, sexual 
excesses, prolonged mental or physical exertion. 
In fact, the man who has hardening of the ar- 
teries, should spend more hours In bed than the 
one whose arteries are normal. 

Sudden change of temperature, particular foods 
and certain forms of activity may be observed 
by the Individual to give rise to uncomfortable 
symptoms, as tightening of the chest, or heart 
flutterlngs. These Inducing causes he must learn 
to avoid. The skin should be kept clean and 
active to promote elimination of waste and to 
prevent sluggishness of the blood In the dimin- 
ished capillaries. 

Arterlo-sclerosis Involves to a greater or lesser 
degree the heart and the kidneys; It may be dif- 
fuse, involving all the organs and tissues of the 
body, or It may be local, affecting only a part, 
as the brain, or a leg. 

The general treatment is hygienic: fresh air, 



144 WHAT HEART PATIENTS 

freedom from nervous strain, regulation of diet 
and of excretions; promotion of elimination by a 
prescribed course of baths, exercise and often 
therapeutic gymnastics; the avoidance of every- 
thing known to be hurtful. 

There Is a trite but true saying that " a man 
Is as old as his arteries." The consensus of 
opinion among medical practitioners of much ex- 
perience Is that a young man with bad arteries Is 
in much more danger in a physical crisis, such as 
pneumonia or typhoid fever, than one many years 
his senior whose arteries are normal. 

Arterio-sclerosis Is known as a progressive dis- 
ease, but If we avoid or eliminate those things 
which are recognised as the preventable major 
causes, namely toxins, It is but reasonable to be- 
lieve we not only can stop the process, but we can 
improve the condition. Hardening of the arteries 
Is but a sign of certain changes taking place In 
the circulatory system, usually involving, as I have 
said elsewhere, the kidneys and heart, thus be- 
coming a synonym for cardlo-vascular-renal dis- 
ease. 

Cardio-vascular-renal disease Is Increasing so 
rapidly among the well-to-do as to become quite 
alarming. Instead of dealing with three distinct 
diseases, we find them linked together, whether the 



SHOULD KNOW AND DO 145 

high blood pressure indicating the diseased condi- 
tion of the arterial wall predominates, or whether 
the urine analysis shows the kidneys to be the 
most prominent factor in the combination of the 
symptom complex, or on further examination the 
heart is found to be the weakest link. When one 
link is involved, all three are involved, and the 
essential thing for the physician is to determine the 
degree of each and direct the treatment accord- 
ingly. The toxins of Infections, intestinal putrl- 
ficatlon, badly used foods, which irritate the 
arterial wall, are especially irritating to the kid- 
neys, causing Bright's disease or the form of kid- 
ney trouble we are now considering. On the other 
hand, the defective function of the kidneys may 
be the cause of the poisons in the blood stream. 
The ill effects of alcohol on Bright's disease are 
due to its interfering with oxidation, and Imper- 
fect oxidation is one of the distinct causes of kid- 
ney disease. Any one suffering with cardio-vas- 
cular-renal disease should, therefore, abstain from 
alcohol In every form. It seems apparent that 
such diet, regulation of habits, physical treatment 
or medicinal treatment should be adopted as will 
prevent or decrease irritation In the alimentary 
canal and thus aid In the prevention and arrest of 
this pernicious disease. 



146 WHAT HEART PATIENTS 

Another habit which Is now recognised as a 
direct cause of this disease Is the taking of such 
drugs as the coal-tar products. As these drugs 
are largely excreted by the kidneys, and are more 
or less Irritating to these organs, they should be 
used with great caution, If at all, when the organs 
are already Impaired. 

I shall not attempt to lay down any fixed rule In 
regulating the diet of those whose kidneys are 
much affected, as It must be regulated carefully, In 
view of the physical and laboratory findings. It Is 
demonstrated that kidneys which are Impaired do 
not excrete table salt well, therefore salt should 
be restricted to a minimum amount. Large 
quantities of fluid mean more work on the kidneys, 
more pressure on the damaged arteries by In- 
creasing the fluid constituents of the blood, and 
consequently greater force for the weakened heart 
to overcome. The fluid Intake, therefore, must 
be regulated according to the blood pressure and 
urine analysis. 

The main object of the stricter regulation of 
diet where the kidneys are Involved Is to allow 
only sufliclent amounts of all the elements neces- 
sary for nutrition. There should be an avoid- 
ance of such foods as cause Indigestion or con- 
stipation or those things which analyses have 



SHOULD KNOW AND DO 147 

proved difficult for the kidneys to excrete. There 
should be sufficient food of the kind to keep up 
the nutritive equilibrium, without adding to the 
body weight. In general, meats may be taken in 
small amounts, not oftener than once a day, and 
recent investigation shows it matters little whether 
the meats be red or light. 

There must be an avoidance of all heavy 
meats: venison, rank game, all kinds of liver, 
especially the diseased liver of geese, called 
pdte de foie gras. Almost all of the fresh vege- 
tables may be freely eaten, also cooked fruits, 
most of the cereals, eggs, bread and pota- 
toes. The selection and quantity of each must 
depend on the Individual and the results of the 
analyses and medical examination. Detailed 
courses of treatment should be prescribed where 
the kidneys are much involved, as general recom- 
mendations are quite unsafe. 

The heart may show varied forms of functional 
or organic disturbances when there are deleterious 
substances In the blood, or when the channels 
through which the blood flows are contracted, 
narrowed or lessened in their elastic response. 
The normal circulation In the body is not unlike, 
but much more wonderful than, a good water- 
supply system to a city, the water itself pure and 



148 WHAT PATIENTS SHOULD DO 

uncontamlnated ; the water pipes clean, open and 
in repair; the well-adjusted engine converting fuel 
into power proportionate to its task, sending the 
refreshing stream far and near, wherever it is 
needed. While even more important than the 
good water system to the health and well-being of 
the inhabitants of the city is the good circulatory 
system to the health and well-being of the in- 
dividual. 



OBESITY 

The disease known as " fatty heart " is, I am 
glad to say, very uncommon, while on the other 
hand, general obesity, giving the heart extra work 
to do and hampering It In Its functions, the fat 
deposits encroaching on the organ, is a condition 
frequently to be dealt with. The sudden taking 
on of flesh and the sudden reduction of the same, 
are alike attended with danger, the vital organs 
needing time to adjust themselves to the altered 
condition. While it is many times necessary to 
reduce the weight, it must be done with the great- 
est precaution, whether the means be diet, exer- 
cise or specific treatment. 

Obesity Is very frequently due to the lack of 
sufficient utilisation of food by the bodily tissues. 
A great reduction of food may not correct the 
trouble; in fact it may exaggerate It and pro- 
duce general debility. Auto-intoxication is not 
infrequently present, to correct which the diet 
must be regulated, with a reduction of animal 
food; the food must be thoroughly chewed, one 
of the preventive measures of obesity, the bowels 

149 



150 WHAT HEART PATIENTS 

well regulated, while exercise promoting elimina- 
tion should be systematically taken. 

Persons suffering from heart and arterial trou- 
bles, with an inclination to too much flesh, are very 
often the dupes of anti-fat treatments advertised 
to do wonderful things in the way of reducing fat. 
There are many things known to medicine which 
will reduce fat, but they do so at such a tre- 
mendous strain on the system that the better-class 
physicians avoid them. No advertised remedy or 
anti-fat treatment should be undertaken without 
the opinion or advice of the family physician, who 
should keep a careful watch for bad effects if 
he think the remedy at all worth trying. Un- 
fortunately most of the victims do not wish it 
known that they are taking these various nos- 
trums, and it is not until serious symptoms arise 
that medical aid is sought. It is often only by 
accident that the physician discovers that the pa- 
tient has been taking something to reduce his 
weight, as it is no uncommon thing that such pa- 
tients vigorously deny that they have been duped. 
Any sudden change in weight, no matter 
whether it be in taking on weight or reducing it, 
should be strictly avoided. 

Anaemia, a deficiency of the blood in quality or 
quantity, is, in many instances, responsible for 



SHOULD KNOW AND DO 151 

obesity as well as for many affections of the 
heart. Pure air, sunlight, nourishing food such as 
eggs, milk, with plenty of vegetables and fruits and 
meat, are recommended. 



METABOLIC DISEASES 

Metabolism, meaning *' change," as its etymol- 
ogy implies, is constructive and destructive, the 
former when foodstuffs in the body are changed 
into com.plex tissue elements, the latter when the 
complex substances are changed into energy. 
Auto-intoxication and gout are classed as meta- 
bolic diseases, because the transformation is not 
normal, the system being unable to make the 
proper changes, or to use well certain kinds of 
food. 

Gouty persons should be particular about their 
daily exercise. Fresh vegetables and fruits, fa- 
vourable to the reduction of uric acid without add- 
ing to the bodily weight, constitute the chief articles 
of their diet. When the meats are much reduced, 
a little fat is often permitted to satisfy the desire 
for animal food. Cocoa and chocolate, although 
but slightly stimulating, and possessing food 
values, are constipating to some persons and bad 
for gout. 



152 



'' LEAKY HEART " 

The heart Is termed, in common speech, " leaky '* 
when one or more of its valves is an imperfect 
fit when closed, permitting the blood to escape 
backward. The imperfect closure may be due to 
a defect in the valve, or the fault may be In the 
orifice, which the normal valve fails to close, be- 
cause of the lack of tonicity of the heart, or the 
trouble may be due to both valves and muscle- 
fibres of orifice. As long as the blood escapes 
backward, the already impaired heart has more 
than its normal work to do to keep up the cir- 
culation and the nourishment of the tissues. Not 
only does the heart muscle itself suffer from lack 
of tissue nutriment, but it is obliged, though 
handicapped and much of Its force wasted, to do 
Its work for the rest of the system. It is obvious 
that such a heart will not be able to meet a de- 
mand made upon it by sudden violent physical 
activity or by prolonged exertion, without very 
great risk. 

Neither a defective valve nor an enlarged ori- 
fice implies necessarily a leak or regurgitation, 

153 



154 WHAT HEART PATIENTS 

as there may be a readjustment of the parts or 
an adequate or entire closure and the heart 
thus enabled to do its work efficiently. A heart 
which has undergone this process ought not 
to be heavily taxed, especially if the change be 
after one has reached the adult age, the youth 
or child more often making a complete recovery. 
The leakage, whether it be referable to functional 
disturbance or to organic disease, may be cor- 
rected or amended by treatment. Whatever the 
nature of the impairment, the general health 
should be looked after, nervous strain and excite- 
ment avoided, giving the heart every opportunity 
to make compensation for the imperfection. 
When compensation is well established the indi- 
vidual should be able to lead a fairly active life, 
free, however, from all imprudence and ex- 
cesses. 

Compensation is said to have taken place when 
the functional or structural defect is counterbal- 
anced, when the deficiency is made good. As to 
illustrate with one form of compensation, — when 
the deficiency in the closure is corrected by a hy- 
pertrophy or thickening of the walls of the heart, 
due to the increased work of the heart muscle. 
When compensation becomes broken, absolute rest 
and medical attendance are necessary to promote 



SHOULD KNOW AND DO 155 

its reestabllshment. A hypertrophy may be either 
an impairment to the organ or a compensatory 
adaptation, a self-protective arrangement of the 
heart by which it overcomes or makes an effort 
to overcome some embarrassment or hindrance; 
hence, as the former being an active disturber, as 
the latter a safety means. 

Dilatation of the heart is an increase in the size 
of one or more cavities arising from a relaxation, 
weakening or lack of tonicity of the heart muscle. 
Being secondary to some other abnormal condi- 
tion, it, like hypertrophy, must always be esti- 
mated in relation to that other condition. 

Rheumatism is the cause of a very large per 
cent of all valvular troubles, so that when we find 
a valvular defect we look for a history of rheu- 
matism. The boy or girl who has rheumatism, 
even in the mild form of " growing pains," or the 
one who has chorea, commonly called St. Vitus' 
dance, should be watched very carefully by the 
parents. Both of these diseases are very fre- 
quently accompanied by valvular trouble. Special 
care is required at this time to see that no Indis- 
cretion is indulged in. Oftentimes over-exercise 
or over-excitement at this time may cause a valv- 
ular trouble that may prove a serious handicap to 
the person a whole lifetime. It should be borne 



156 WHAT HEART PATIENTS 

in mind that rheumatism is a child's disease, in- 
deed it may even attack the babe before birth, 
and it is no infrequent occurrence to have children 
born with a valvular defect due to an attack of 
this insidious disease on the child during prenatal 
life, causing what is known as congenital valvular 
disease. 

Rheumatism is particularly prone to attack the 
heart in childhood and in early adolescence, even 
when the joint symptoms cause little or no swell- 
ing or but slight discomfort. These slight attacks 
are usually called by the " knowing ones " grow- 
ing pains, and are given no attention until later 
it is found the child has a serious valvular trouble 
which might possibly have been avoided, had the 
proper precautions been taken in time. Rheu- 
matism in later adolescence is not so liable to at- 
tack the heart. 

Valvular trouble may also be caused by erysip- 
elas or many other acute febrile diseases, and a 
very insidious feature of this trouble is, that the 
valvular defect does not manifest itself for some 
time after the acute stage of the disease has 
passed away. This feature has been the cause 
of many serious troubles. The child examined 
when the acute stage is over and no evidence of 
valvular trouble discovered, he is allowed to go 



SHOULD KNOW AND DO 157 

out and play or indulge in too violent exercises 
until attention is called to his difficult breathing, 
when an examination reveals a marked valvular 
defect; indeed years may elapse before the valvu- 
lar trouble manifests itself. 

Then again we have valvular trouble coming 
from severe strain, found not infrequently in ath- 
letes, long-distance runners, football players, or in 
young men who go into severe physical strains 
without proper training and without proper med- 
ical examination and supervision. When one con- 
siders the physical strain of these athletes and 
gladiators, it is truly remarkable to know the al- 
most limitless capacity for endurance of the hu- 
man organism, when the training is properly and 
gradually developed. 

When a child is convalescing from rheumatism, 
diphtheria, scarlet fever, pneumonia, erysipelas, 
typhoid fever, in fact any septic contagious dis- 
ease, he should be watched most carefully as to 
exercise. His exercise should be increased very 
gradually each day and never to the point of 
fatigue. By this systematic gradual exercise, he 
will soon regain strength, and the weakened heart 
gradually grow stronger until it returns to its 
usual capacity. For it should be remembered 
that no septic infectious disease, such as is 



158 WHAT HEART PATIENTS 

above mentioned, ever attacks child or adult 
without weakening the natural strength and 
endurance of the heart. This is not necessarily 
lasting, and in the great majority of cases, 
by careful living for a time, the heart will 
regain its normal strength; but the normal 
reserve force of the heart should be carefully 
tested before medical vigilance is abandoned. 

The only means the doctor has of making a 
positive diagnosis of valvular disease is by a valv- 
ular murmur, and as I have said above, this may 
occur weeks, months or even years after the real 
cause has passed away. A large per cent of valv- 
ular defects In children, which come to the notice 
of the specialist, can be traced back to some little 
indiscretion following one of the above diseases. 
I can imagine an anxious parent asking how long 
a child should be limited in its physical exercise 
after suffering from a septic fever. This ques- 
tion must be answered by the doctor in charge, as 
there is no rule to guide one in answering such a 
question, for each individual must be limited ac- 
cording as the poisons generated in the disease 
have affected the heart of the child, and this does 
not depend on the severity of the initial disease. 

I wish here to correct an erroneous idea in the 
mind of the laity, which is, that a valvular defect 



SHOULD KNOW AND DO 159 

is always fatal. The seriousness of the trouble 
depends on the degree of damage and on the heart 
muscle. If the muscle fibres of the heart walls 
are in normal condition and ordinary care be 
taken by the patient, a slight valvular lesion may 
be present for years without giving serious 
trouble. When a leaky valve is discovered, It 
simply means the patient must be a little cautious 
about violent exercise and other indiscretions. He 
should also visit his family physician three or four 
times yearly for a careful examination, following 
religiously every detail of the advice given him. 
Following this advice Is usually no hardship, and 
may prevent a serious misstep that could be easily 
avoided. I have walked, played golf and climbed 
three flights of stairs with a patient who had a 
marked leaky valve, and he did his exercise with 
apparent ease and comfort. The muscle fibre of 
the heart walls was normal, the tone was good 
and there was no indication of any lack In the 
reserve force in the heart muscle and no other 
functional disturbance present. This man Intelli- 
gently accepted his limitations and followed con- 
scientiously the advice given him. 



WEAK HEART 

Many persons who complain of weak heart have 
not the first sign or symptom of such weakness. 
This is particularly true of young people who are 
pale, and delicate in general build, and who grasp 
at this expression of " weak heart " as satisfying 
themselves and their friends for not being as 
strong and robust as their companions. A large 
per cent of this class are girls who think, and 
indeed convince their family and friends, that 
their hearts are very v/eak and their circulation 
very poor. These people complain of cold feet, 
cold hands, and do suffer from both, and they 
reason that the weak heart is the cause. 

When one of these persons is examined, her 
heart may be found to be normal, with no indica- 
tion of any weakness, the blood also showing no 
deviation from the normal. A careful examina- 
tion reveals a weakened or over-sensitive nervous 
system, and when she can be prevailed on to get 
out in the fresh air and play tennis, golf, ride 
horseback, take long walks, go camping for sev- 
eral weeks, in fact, live out of doors, we soon find 

i6o 



WHAT PATIENTS SHOULD DO i6i 

the " God of the open air " brings about a marvel- 
lous improvement in appetite, In colour, in spirits, 
In every way, physically and mentally. When I 
speak of " weak heart," I mean a weakened con- 
dition of the heart muscle. In general, this trou- 
ble Is caused by the same infectious and contagious 
diseases which cause " leaky heart." Here again 
we find rheumatism the greatest sinner. 

Weak heart may be caused or superinduced by 
rheumatism, diphtheria, scarlet fever, pneumonia, 
typhoid fever, whooping cough, lead poisoning, 
ptomain poisoning, specific diseases, and many 
other general or systemic troubles. It Is thought 
that most of these diseases cause weak heart by 
generating a poison which acts directly on the 
heart muscle. All septic contagious diseases 
have a weakening effect on the heart and 
should always be regarded with much caution 
in this respect. This caution Is particularly nec- 
essary with children, who during convalescence 
from these diseases are apt to indulge in too 
active exercise while the heart is still under 
the effects of this poison. Any one suffering from 
these septic diseases or toxin-producing diseases 
should be kept very quiet until the excretory or- 
gans, the kidneys, bowels, skin and lungs have 
ample time to rid the system of all the ptomains 



1 62 WHAT HEART PATIENTS 

generated by the disease, before being allowed 
to Indulge In any active exercise that will tax the 
weakened heart. 

A long-continued high blood pressure will also 
cause a weakened heart muscle. The high blood 
pressure causes an increased resistance for the 
heart to pump against. In the effort of the heart 
to overcome this increased resistance and keep 
up the normal blood supply to the tissues, the 
heart muscle first becomes thickened or hypertro- 
phied and later becomes atrophied, or begins to de- 
generate, which is manifest by a stretching of the 
muscle or a dilatation of the heart, mpre par- 
ticularly one or both of the ventricles. 

One of the first symptoms of heart weakness Is 
shortness of breath. This may come on gradually 
or It may be brought suddenly to the notice after 
some such little exertion as would not usually in- 
crease the breathing noticeably. A New York 
banker, forty-eight years old, left his office to re- 
turn home after an unusually busy day at his 
desk. On going to the elevated he heard the train 
coming and rushed up the stairs just In time to 
catch the car, but almost out of breath and 
*' feeling giddy," as he expressed it, but was 
fortunate in finding a seat and soon recov- 
ered his equilibrium; but his breathing continued 



SHOULD KNOW AND DO 163 

laboured and alarmed him to such an extent 
that on reaching home he telephoned his 
physician, who found a marked dilatation of 
the heart and advised prolonged rest. Not 
being satisfied with the diagnosis of the family 
physician, a consultant was next day called in 
and the diagnosis confirmed. The consultant also 
insisted on absolute rest. This is such a typical 
history of these cases, one which came to my no- 
tice recently, that I have used it here to show the 
often sudden and very unexpected onset of this 
trouble. 

What I have said in another chapter on 
valvular defects on the results of the septic 
infectious diseases may also be said regarding 
weak heart. Indeed one of the ways these diseases 
produce valvular defects is by weakening the heart 
wall and causing it to dilate until the valves no 
longer come together, thus permitting the blood to 
escape backward. A weakened condition of the 
heart wall may result in a dilatation, a drawing 
apart of the valves, giving rise to a leak or re- 
gurgitation. This naturally puts extra work on 
the heart, and in meeting this extra demand 
the walls of the heart become thickened or hyper- 
trophied, as the blacksmith's arm thickens by the 
constant use of the hammer. This is what is 



1 64 WHAT HEART PATIENTS 

meant by compensating hypertrophy, as in many 
cases the hypertrophy may fully compensate for 
the defect in the valve and the leak be closed. 
Parents should bear in mind that Nature's method 
of developing the heart and blood vessels is by 
physical exercise. The child should be encour- 
aged to romp and play. The young boy and girl 
should take long walks, be taught all the out- 
door games and be in the open air as much as 
possible. 

Air Hunger. — Air hunger may be of bronchial 
origin or of cardiac origin, the latter due 
to a weak heart, the form which we shall 
consider here. Unfortunately, too often this 
" air hunger " is attributed to getting stout or 
putting on flesh, and is passed over as in- 
significant, until some more serious symptom 
manifests itself and causes the person to take 
notice. The first thing which attracts the atten- 
tion of the individual is difficulty in breath- 
ing on slight exertion, as walking on the 
level or more particularly walking up a slight in- 
cline. This may mean but a temporary weakness 
of the heart and it may mean something more 
serious. There are other conditions, it is true, 
which may induce distress in breathing, but breath- 



SHOULD KNOW AND DO 165 

lessness Is so often associated with weak heart that 
every Indication of " air hunger " should be suf- 
ficient cause for careful Inquiry into the condition 
of the heart. It Is In the early stage, when the 
insidious symptoms cause no personal discomfort, 
when the trouble creeps so sneaklngly onward as 
to arouse little suspicion, that the condition should 
be looked Into. 

Cardiac asthma Is one form of air hunger due 
to a weakened condition of the heart and Is often 
the first sign or symptom of a restriction In the 
field of cardiac response, when the heart Is no 
longer able to respond to even a small Increased 
demand of the tissues for oxygen, as occasioned 
by slight exertion. This form of asthma Is more 
common in elderly persons than In the young or 
middle-aged. 



ANGINA PECTORIS 

Persons suffering from the pains of angina 
pectoris, who live in fear of another attack when 
they are free from pain, will want to know first 
how the repetition of the attacks may be warded 
off. Until the cause of the pain is removed, in 
some cases possible while in others Impossible, 
there will be a recurrence of attacks, though their 
frequency may be greatly decreased by avoiding 
the things which directly induce them — walking 
too rapidly, walking against the wind, ascending a 
hill or going upstairs without frequent rests, walk- 
ing immediately after meals, lifting or reaching, 
as changing the position of a heavy chair, reach- 
ing to high shelves for books, stooping to lift ob- 
jects from floor or to put on shoes, mental or phys- 
ical exertion, sudden change of temperature, as 
going out from a warm room Into the cold or sit- 
ting in a heated room in the direct draught of an 
open window, undressing or dressing in a cold 
room, contact with cold sheets, over-fatigue caused 
by the effort of hurried dressing and undressing, 
cold baths, excitement, the taking of gas-forming 

i66 



WHAT PATIENTS SHOULD DO 167 

or constipating foods, neglect to relieve the bowels 
at a regular time. 

Of more importance than the attacks and their 
Immediate causes are the primary causes of the 
trouble and the counteracting measures — the 
anaemic who are suffering from poor nourishment 
should be properly nourished, the excessive eater 
or drinker restrained, over-work and over-worry 
avoided, alcohol, tea, coffee and tobacco refrained 
from; last but not least, the condition of the heart 
and arteries ascertained and treated, and medical 
advice for the individual observed to the letter. 

Angina pectoris, whether it be considered a 
sign of disease, a pain in the chest, as the term 
signifies, or a disease itself, of organic or func- 
tional nature, is a grave trouble, but not an in- 
curable or irreparable one. 

Professor William Osier * recently defined an- 
gina pectoris as '' a disease characterised by 
paroxysmal attacks of pain, pectoral or extra 
pectoral, associated with changes In the arterial 
walls, organic or functional." It seems evident 
that the trouble in the better class of society is 
increasing, particularly In America, due to the 

*In his lectures delivered before the Royal College of Phy- 
sicians of London, March 10-15 and 17, 1910. 



1 68 WHAT HEART PATIENTS 

high pressure of our twentieth-century life. The 
stress, strain and worry incidental to large busi- 
ness enterprises form one of the most potent basic 
factors in causing this disease. My object in 
bringing angina pectoris to the notice of the public 
is to teach men and women the essential char- 
acteristics of the disease, that by learning the na- 
ture of the trouble and seeking medical advice 
early, much suffering may be avoided. 

A pain recurring in the same location repeat- 
edly or under the same or similar circumstances, 
should have the careful attention of a physician. 
The sufferers may be divided into three great 
classes. The first and by far the greatest is the 
neurotic class, or worry class. Secondly, those 
who have history of toxic diseases or who con- 
tinue to poison their systems and contract or irri- 
tate their arteries by tobacco. The third class, 
those whose misfortune or errors have already 
led to a degeneration in the arterial walls, usually 
met with late in life. 

Pain. — Unfortunately, in many severe forms of 
heart disease there is no indication of pain, which 
is unfortunate, because the patient may not realise 
his trouble, or its seriousness, before it is too late. 
Even in the acute stage, inflammation of the heart 



SHOULD KNOW AND DO 169 

with ulceration, there Is seldom any pain. Ulcera- 
tion of the valves may proceed to an extreme de- 
gree without an Indication of pain. On the other 
hand, the arteries are capable of causing the most 
Intense pain, as every one can attest who has 
suffered from frostbite and experienced the In- 
tense pain caused by the rapid dilatation of the 
blood vessels. You recall how you paid for the 
pleasure of your snowball frolic In your childhood 
when you entered the warm room. If the mistake 
were made of putting the hands In warm water, 
the pain was Intensified by the more rapid dilata- 
tion. 

A person suffering from angina pectoris has a 
great fear of Impending danger. I do not wish 
to be misleading In this too often serious trouble, 
but let me bring a few facts to the notice of per- 
sons suffering from pain In the region of the heart. 
First : A great deal of pain located In the left chest 
is nothing more than intercostal neuralgia. Sec- 
ond: A great many pains that even simulate 
angina pectoris are of neurotic origin and are 
called pseudo angina pectoris. Third: The per- 
sons who think they have real angina are almost 
sure not to have it. Fourth: Patients suffer- 
ing from angina pectoris have been known to 
live for many years. Fifth: Patients have been 



lyo WHAT HEART PATIENTS 

known to make complete recovery from the trou- 
ble. Some of the best diagnosticians I have known 
have reported cases who have lived many years 
after their first attack. Many of these pains are 
brought on by poisons, as for instance tobacco 
angina, which is greatly relieved by stopping the 
cause. 

With the early recognition of the trouble, 
that one may regulate his life to the altered condi- 
tions, changing the diet to meet the present de- 
mands, changing or correcting habits of work or 
exercise, with judicious treatment under the care- 
ful and close observation of the physician, the 
prognosis may be very much brighter. It is well 
to emphasise here that any pain in the chest 
should be looked carefully into by a physician. 
When the first indication of pain occurs, 
which is usually first a feeling of tightness, it is 
a danger signal. When a man feels a sense of 
tension beneath the breast bone it is a warning 
that there is too much pressure on the machinery, 
and unless there is an easing up a break may occur 
at any time. 

All authorities agree that worry causes a very 
large per cent of this distressing disease. Men 
worry because their millions do not come to them 
fast enough. Men try to live at such a pace to- 



SHOULD KNOW AND DO 171 

day that any depression in business starts them 
worrying about the disaster and ruin which they 
see engulfing them. They cannot reduce their 
army of clerks or cut down the large domestic 
force, fearing the neighbour across the way will 
see in this the first evidence of financial decay. 
Many are unbalanced enough to keep up the blufi 
and worry themselves into their graves. 

Reader, let me say: " If your business worries 
you, sell it, or your executor soon will, and you 
can settle up your affairs better than your widow 
or your heirs; you are much more valuable, or 
you ought to be, as a husband and father than as 
a memory. If your load is keeping sleep from 
your eyes and peace from your soul, drop it — 
the sooner the better ! Have the courage to face 
a more modest life. If your son does not have 
the best box at the opera next season he may have 
more time to cultivate the acquaintance of his 
father and perhaps learn some of the things 
really worth knowing in this life. Live within 
your means and enjoy the peace the Creator in- 
tended every man should enjoy." 

Angina pectoris is an affection of the ar- 
teries, the pain being due to a spasm of the 
arterial wall. Understanding this, it Is easy to 
realise that we may have anginal pains in any 



172 WHAT HEART PATIENTS 

part of the body. There Is no doubt that heredity 
plays an important role in this disease. It is im- 
possible to inherit the disease, but a condition in 
the arteries may be inherited that tends to this 
form of arterial trouble. One remarkable feature 
of this disease is, that it is almost entirely confined 
to the robust and strong, attacking the male sex 
much oftener than the female. Seldom does this 
disease attack the weak or the chronic invalid. It 
is usually the man who is keeping the engines at 
full speed ahead, the man who is active in mind 
and body, pursuing his vocation with a vigorous 
energy, who is bound to wreck the engine sooner 
or later. The disease usually occurs between the 
ages of forty-five and sixty years, at a time when 
the engine is kept working at its highest speed. 
When it comes it is a warning that the engine 
has been kept at too high pressure for too long 
a time, and where heed is taken, may be the means 
of prolonging the life of the individual. The 
disease is peculiar, inasmuch as there is no symp- 
tom or set of symptoms which gives any positive 
clue to the prognosis, and consultants have learned 
to base their prognosis on the ability or readiness 
of the patient to carry out the instructions. 

Experience has taught physicians that the prog- 
nosis depends almost entirely on the life the pa- 



SHOULD KNOW AND DO 173 

tient is willing to lead. It is frequently found that 
the entire trouble subsides when our pace-making 
business or professional man slows down the 
speed, gets out from under his load, gets away 
from the strain and worry of his environment. 
Travel will often cure a severe case of angina 
pectoris; an ocean voyage is often a specific rem- 
edy. I have known severe attacks of anginal pains 
to subside completely in twenty-four hours after 
the subject left land. Ocean voyages are not a 
specific for all forms of angina ; if they were, the 
liners would be crowded at all seasons. Some 
have not the ability to leave their worries on shore 
and must carry them as long as consciousness lasts. 
Others can throw off their cares when they leave 
the roar of Broadway, the telephone ticker, and 
early realise there is real life outside the great 
rush. 

A number of neurologists have given serious 
thought to the study of this ^' hurry-up game " 
the men of the twentieth century are playing. 
This game of bluff which the great majority are 
Indulging in Is foolish enough to be ludicrous had 
It not such a serious termination. Some writers 
seem to think that in the next few generations the 
human system will so adapt itself to the rush that 
there will be no danger of arterial degeneration 



174 WHAT PATIENTS SHOULD DO 

or angina pectoris to the man of the next century. 
Studies thus far have led to no discovery of any 
resistant germ in the human that will render 
the body immune to the natural results of such 
irrationalities. 



NERVOUS HEART 

The nervous heart manifests many phenomena, 
the most common of which are heart irritability, 
palpitation, intermittent pulse, irregular pulse, 
rapid pulse and heart pain or heart neuralgia. 
Palpitation is much more common in women than 
in men, due no doubt in a measure to their more 
emotional life, to their closer confinement to the 
house and lack of outdoor exercise. The inherent 
lower nervous tone of women, their mode of life, 
their irrational dress, all tend to induce a sus- 
ceptibility to nervous phenomena and render them 
much more subject to nervous heart than men. 
The pernicious habit of coffee drinking is ac- 
countable for more nervous phenomena of the 
heart than any other one thing. The predomi- 
nating cause of the irritability of the heart in men 
is the abuse of tobacco or abuse of themselves by 
the use of tobacco. Other causes are sedentary 
habits, dissipation, excesses of all kinds, of eating 
and of drinking, outbursts of violent passion, etc. 
The cause may often be an attack of indigestion, 
of gases in the stomach, or sudden fright. Violent 

175 



176 WHAT HEART PATIENTS 

exercise, such as running for a street car or sudden 
or rapid exercise after a hearty meal, may bring 
on an attack of palpitation. In some instances, 
" heartburn " or hyperacidity brings on an at- 
tack. 

These attacks are more often functional than 
organic, and though they are annoying to the 
patient, they rarely indicate any serious heart dis- 
ease. Distressing as these attacks are, lasting only 
a few minutes or even a few hours, they often pass 
off, leaving the person seemingly none the worse, 
though the reserve power of the heart is more 
or less overtaxed. 

The immediate inducing causes of the attacks 
are as a usual thing not difficult to discover and 
avoid, apprehension retarding or preventing re- 
covery. The majority of patients soon learn 
what the exciting causes of such attacks are and 
learn to avoid them. I know a young man, a user 
of tobacco to excess, who has an attack of palpita- 
tion if he runs a short distance or hurries up a 
flight of stairs. In others, the eating of certain 
foods will induce an attack. Indeed there are 
many different causes which will excite an attack, 
and which the person may soon learn to guard 
against. 

An attack may sometimes be overcome by 



SHOULD KNOW AND DO 177 

sitting or lying quietly and taking twelve to 
fifteen slow, very deep, breaths. In many cases 
I have found deep breathing an effective measure 
and one, in most instances, easily employed by the 
patient afterwards. Naturally, if the exciting 
cause is an overloaded stomach or an accumula- 
tion of gas in the bowels, the cause must 
first be removed by treatment or diet, as 
many of the persons suffering from palpitation 
have a depleted nervous system from some 
specific cause, such as tobacco, alcohol, over- 
eating, etc. 

To improve the nervous system a trip to 
the mountains or seaside is often beneficial. If 
this is impracticable, a change of scenery can be 
had by a visit to the country or elsewhere. If the 
attacks occur at night or after certain meals, the 
time of taking the evening meal should be regu- 
lated and nothing taken for that meal which will 
cause indigestion and gas. Should the attacks 
come on after heavy meals, light meals with food 
between times should be taken, that the appetite 
be appeased and temptation to overeat avoided. 
If a person suffering from palpitation is using 
more than one small cup of coffee for breakfast, 
he should stop it, as caffeine, the alkaloid of 
coffee, is a powerful stimulant to the nerves of 



178 WHAT HEART PATIENTS 

the heart and is frequently the exciting cause of 
attacks. I have known two cups of coffee to 
bring on such a violent attack of palpitation in a 
strong man as to cause fainting. Such a person 
should not use coffee at all; indeed any person 
with an irritable heart should abstain from drink- 
ing coffee in any quantity or form. So many have 
the idea that diluting the coffee with quantities of 
milk renders it less harmful. It is the amount of 
coffee taken that does the mischief. Two table- 
spoonfuls of strong coffee of the best grades may 
contain more caffeine than a quart of a cheap 
grade, a large per cent of which is chicory or 
cereal. 

A depleted nervous system may manifest itself 
through the heart by an intermittent heart beat 
or an intermittent pulse. This is rarely indicative 
of heart trouble or organic heart disease, and is 
usually attributable to a nervous irritation of the 
heart which does not allow the ventricle to fill 
with blood, therefore occasioning an incomplete 
contraction, the wave of which is insufficient to 
be felt at the wrist. An intermittent pulse is oc- 
casionally met with in strong, healthy persons, 
who, notwithstanding, may live to a ripe old age. 

Under no circumstances should a patient take 
his own pulse, as it only tends to keep the 



SHOULD KNOW AND DO 179 

mind dwelling on what Is more often a supposed 
trouble than a real one and teaches him nothing. 
If the pulse is too fast he worries about it, be- 
comes excited over it and only adds fuel to the 
fire. Should it be necessary, for any reason, to 
watch the pulse it must be done by the physician 
or trained nurse. 

Irregularity of the heart beat is somewhat dif- 
ferent from the intermittent beat, though the 
irregularity may be due to the same cause, an over- 
wrought nervous system. Irregularity may, how- 
ever, be due to or associated with a valvular dis- 
ease, and should have proper medical attention. 
Where it is found that the temporary attacks are 
due to tobacco, coffee, tea, alcohol or indigestion, 
the remedy is simple and relief sure on the with- 
drawal of the exciting cause. The cause must, 
however, be determined by the physician, if not 
obvious enough to be seen and corrected at once. 
Should a cup of coffee or tea or a strong cigar 
cause an attack of irregularity of the heart beat, 
it ought not to require the services of a physician 
to apply the remedy. 

Pain in the region of the heart, unfortunately, 
cannot always be classed as a functional dis- 
turbance, but it is so often of purely functional 
or nervous origin that I feel justified in describ- 



i8o WHAT HEART PATIENTS 

ing it under functional troubles. There is no 
symptom which causes such apprehension of heart 
trouble as does pain in the chest. . Pains in 
the chest are often referred to the heart, which 
have absolutely nothing to do with that organ. 
These pains may come from the lungs, muscles 
of the chest, stomach or from the intestines. In- 
tercostal neuralgias are most often mistaken for 
heart pain, and particularly when on the left side 
of the chest, causing the scare of heart disease. 
Cardiac, or heart neuralgia, is not a common 
trouble, and when it occurs often or continues for 
any time, should have medical attention. In real 
heart pain, the cause is most often due to poisons 
or the action of these toxins on the tissues of the 
heart. Tobacco is again the most active agent. 
The toxins left after a depressing illness may 
cause pain in the heart. Sudden shock or great 
emotion will frequently bring on a severe attack 
of heart pain, while a violent fit of anger may 
cause an attack of pain in the heart of such 
serious nature that it becomes imperative for the 
high-tempered person to so regulate his life as to 
avoid the irritating conditions which cause such 
loss of self-control. Far better is it for such a 
person to live in the peace and quietude of the 
mountains or country than to die prematurely in 



SHOULD KNOW AND DO i8i 

the whirl and din of a great city. Thousands of 
men and women are whirling along in the terrific 
maelstrom of business and social life in the great 
cities to a mild form of suicide. 

In functional disturbances, particularly where 
such disturbances are accompanied by pain in the 
region of the heart, there is always more or less 
anxiety. In fact, the feeling of apprehension is 
frequently more intense than the actual pain. I 
have seen this anxiety so intense as to cause pal- 
pitation of the heart, cold perspiration of hands 
and feet and other nervous symptoms in persons 
in whom the most careful examination failed to 
reveal the first indication of heart disease. These 
pains are oftentimes severe and the anxiety hard 
to endure, yet often so distinctively different from 
the real angina pectoris that no one should mis- 
take them. A careful examination by the family 
physician may relieve the dread and consequently 
relieve the whole trouble. 



RHEUMATISM 

Acute articular rheumatism, or rheumatic fever, 
was first described In the middle of the eighteenth 
century by Boerhaave, a distinguished Holland 
physician, who, himself a sufferer, wrote quite 
accurately of the symptoms, giving a most lucid 
account of the disease. For years, the disease was 
thought to be due to chemical changes in the 
blood. More recent investigations, however, have 
shown that it is probably of bacterial origin. 
There are many forms of arthritis, some affecting 
one joint and some attacking many joints. These 
may be due to several causes, and should not be 
confounded with rheumatic affections. 

What is known as rheumatism may be defined 
as an acute or subacute specific fever attributed to 
bacteria, having an indefinite and variable dura- 
tion, from a few weeks to a number of years, with 
well-defined clinical symptoms, the most constant 
of which is, inflammation of the heart and one 
or more joints of the body. So commonly is the 
heart involved in this disease in the young, that 
one English author Insists that it should be called 

182 



WHAT PATIENTS SHOULD DO 183 

" heart fever," instead of rheumatic fever. The 
duration of the disease may be indefinite, 
not infrequently determined by the heart symp- 
toms, which may continue for some years. One is 
impressed in reviewing reports of heart specialists 
on cases of heart trouble in patients under thirty 
years of age, with how many are attributed to 
articular arthritis of childhood, perhaps unrecog- 
nised at the time. I might add, a large per cent of 
heart trouble found later in life is traced to the 
same cause. Every child complaining of pain in 
the joints or limbs, or noticeably short of breath, 
should be kept quiet, preferably in bed, until as- 
sured by a physician that exercise may with safety 
be resumed. 

Rheumatism is essentially a disease of child- 
hood, often occurring very early indeed, not in- 
frequently attacking the child in prenatal life, 
leaving its pernicious scar on the heart valves and 
producing a congenital heart murmur which the 
child may carry all through life. Mothers, during 
pregnancy, should keep themselves as free from 
rheumatism as possible, by avoiding the Inducing 
causes, such as colds, and by taking care of their 
general health. 

Rheumatism in the young is now considered 
one of the most serious diseases of early life, and 



1 84 WHAT PATIENTS SHOULD DO 

is directly responsible for crippling most of the 
defective hearts found in adults. It is my experi- 
ence and the experience of most practitioners that 
when a child is attacked by rheumatism, no matter 
in what form, the heart is almost invariably in- 
volved, and indeed in a large per cent the heart 
is the principal seat of the infection, the joint and 
muscular manifestations being so slight as to al- 
most escape notice. What I wish to impress on 
the minds of parents is the established fact that 
the heart is the child's most vulnerable part, the 
poison of rheumatism, the invading germs attack- 
ing the heart in such numbers as to cause an in- 
flammation of the heart walls, called rheumatic 
carditis, that the poison of these germs often pro- 
duces paralysis of the heart muscle, with subse- 
quent dilatation. 

A child with rheumatism, or growing pains, 
should be watched most carefully. The diet 
should be regulated to prevent indigestion, the 
bowels should be kept very regular, the exercise 
should never be violent or exhausting. The cloth- 
ing should be warm and comfortable, guarding 
against abrupt changes in temperature. The child 
should have plenty of fresh air at night, as well as 
during the day. 



GENERAL ADVICE 

It Is the patients of middle age and upward who 
consult the physician for the amelioration of the 
results of sins against equanimity of living. To 
those who are beginning to suffer from the toxic 
effects of disturbed digestion due to a derange- 
ment in the dynamics of the Intra-abdominal 
blood pressure, the physician may advise modera- 
tion, with a reasonable assurance the advice will 
be heeded. It Is, however, for the great horde of 
the younger generation that the gospel of mod- 
eration Is most needed. 

To the young men and young women whose 
excessive and manifold over-indulgences are 
threatening the energy and life of nations, I 
should most like to spread words of warning; the 
young men against excessive smoking. Irregular 
eating, particularly at night, against the revolting 
habit of bolting food, against Indulging In ex- 
cessive feats of strength without careful and long 
preparation, against Irregular hours and loss of 
sleep, against the strain and excitement of high- 
speed motoring, and against that most deadly of 

185 



i86 WHAT HEART PATIENTS 

all, " sowing of wild oats/' The young women 
I must warn against excessive coffee and tea 
drinking, frequency of social gatherings and 
against the greatest of all sins among young 
women, the tendency to ignore the importance of 
attending promptly to the calls of nature, allow- 
ing slight extraneous influences to postpone in- 
ternal necessities at the expense of serious de- 
rangement in a vital physiological function. 

These excesses, these irregularities inevitably 
lead to an arterial condition which causes human 
beings to grow old long before their time. It Is 
difficult to estimate the economic value to a coun- 
try of the loss of activity of men who are impaired 
mentally or physically, partially or completely in- 
capacitated for life by deranged circulatory func- 
tions. The efforts of the medical profession have 
been principally directed toward lowering the 
frightful infant mortality. This effort is being 
crowned with excellent success. Laudable as this 
movement is and the rich results it is yielding, we 
should not forget the almost criminal negligence 
of the middle-aged, still left exposed to many dan- 
gers as they rush for the top of the hill of suc- 
cess. The medical profession must give the mid- 
dle-aged more serious thought, for although we 
may be unable to stem the mad rush, the almost 



SHOULD KNOW AND DO 187 

inhuman waste of energy, we can In a measure 
regulate the habits of patients so as to mitigate 
their chances of physical breakdown. 

To be successful In business a man must recog- 
nise early symptoms of debility or weakness In the 
market. He learns this by constantly keeping his 
fingers on the commercial pulse. If he discovers 
any premonitory symptoms of depression in the 
market, which may affect him, he immediately 
takes active and vigorous steps to avoid heavy 
losses, and by so doing, often avoids temporary 
embarrassment or total ruin. Our business men 
should use the same sagacity, the same common 
sense about their own physical well-being. 

The sedentary life of a large portion of our 
men and women of to-day tends to cause conges- 
tion of the abdominal organs, which, coupled with 
mental strain and errors In alimentation, reduces 
the bodily powers. 

Every one who has any heart trouble should 
be under the care of a physician. It Is quite safe 
to say that any regular, respectable family physi- 
cian is In a position to give a heart patient 
much more rational and honest advice than 
is an advertiser. Most of the persons who 
are dupes of quacks have received proper advice 
from their physicians, but they want to be cured 



1 88 WHAT HEART PATIENTS 

with no effort on their own part, or to find a 
short cut to health. They ignore diet restrictions 
impressed upon them by their physician, they ig- 
nore exercise limitations enjoined upon them, in 
fact indulge themselves in every way, ceasing to 
carry out their part of the treatment as soon as 
they are better. " My doctor says I have a dis- 
eased heart and wants me to stay at home to rest 
or to go to a distant health resort. I don't believe 
there is anything wrong with my heart." 

Why will men refuse to apply the same business 
sense to their health that they do in business af- 
fairs? If one of these was told by his engineer 
that something was wrong with his factory ma- 
chinery, he would probably believe him or call in 
an expert to verify or disprove the statement, as 
he would not like to afford taking the risk of stop- 
ping the works, or to risk breakage, burning or 
explosion through defective machinery. This is 
the reasoning ninety-nine out of every hundred 
business men would follow and act upon, while 
just about the same per cent will show the most 
wanton ignorance in taking care of their own 
health. 

To these men I want to say this : " Ask yourself 
this question, ' Does my doctor really see some- 
thing in my condition that I cannot see or feel? ' " 



SHOULD KNOW AND DO 189 

Unfortunately It too often happens that the pa- 
tient cannot see or feel the real seriousness of his 
condition. A doctor who would exaggerate a pa- 
tient's condition just to get a fee is worse than a 
thief. From the latter one's locks and bolts will 
protect him, while the former is subject to no law, 
civil or divine. If you have no confidence in your 
doctor's judgment, by all means go to one in whom 
you can have confidence. Listen to what he says 
and follow his advice as implicitly as you would 
the advice of your legal adviser were you in a 
court of justice being tried for your life. 

Any man who reads these pages may sit down 
and recall ten men of affairs who have died sud- 
denly of heart trouble, the majority of whom, no 
doubt, could have lived much longer, or to a good 
old age, by proper regulation of their lives, men 
who showed the most ignorant and reckless indif- 
ference to their own condition. If these same men 
had been on trial for their lives they would have 
spent their last dollar and tried to move heaven 
and earth to save the very lives which they them- 
selves so carelessly sacrificed. 

Some persons take pride in posing as different 
from other people, of less destructible substance, 
not of the common material of other men. Al- 
though they see their acquaintances dropping out 



I90 WHAT HEART PATIENTS 

of the ranks, yet they act and live as though illness 
can never affect them. Some men have the false 
idea that they would be forever disgraced if for 
the sake of their health they should leave their 
post of duty for a short vacation and become a 
*' grunty old woman," as many express it, or 
that their friends at the club or bank or office 
should know that they have hardening of the 
arteries or a leaky valve or a dilated ventricle. 

There is in these cases a nice question of psy- 
chology. Most men so afflicted are ambitious, 
selfish in not making every effort to protect them- 
selves for their families, and often simply refuse 
to accept the true seriousness of their own con- 
dition, while if another member of their family be 
so afflicted they are over-solicitous. 

The traveller observes with a certain feeling of 
security the careful inspection of a fast train at 
every stop, men under every car, each part being 
carefully examined. A railroad president or man- 
ager would think it bad business policy to neglect 
these important details. He would consider it too 
much risk for the slight expense and trouble. Yet 
perhaps this same president is rushing through 
life at a pace equal to that of the limited express 
on his road, with stops few and far between, neg- 
lecting at the stations to have an examination of 



SHOULD KNOW AND DO 191 

his own human machinery until a breakdown oc- 
curs. Then he telegraphs for the Wreck Doctor. 
The machinery may be patched up, but unfor- 
tunately It is too often beyond repair. 

Experts can tell us to the fraction of an ounce 
the number of tons pressure a given piece of steel 
will stand. Business men demand such knowl- 
edge; but these same business men will demand 
of their own flesh and bone a pressure and strain 
they would not expect from iron or steel. These 
same men, who show such business shrewdness, 
are, strange to say, often the ones who show the 
least common sense about their own physical con- 
dition. These are the men who have for years 
boasted of never being tired. They have inherited 
a good constitution, and through dire ignorance, 
wanton indifference and criminal neglect to 
human limitations have so misused their sturdy 
heritage as to become wrecks, fit only for the 
scrap heap at an age when they should be in the 
full vigour of manhood. 

Significance of Rheumatism. — Now a word to 
parents. The " growing pains " of which your 
child complains are probably rheumatism, not to 
be treated lightly, as injury may be done to the 
heart, making serious trouble later on. The 



192 WHAT HEART PATIENTS 

proper attention and care In time may save much 
suffering and sorrow in later years. 

Tonsillitis is but a form or manifestation of 
rheumatic disease, and in many cases in children 
there is a very close connection between tonsillitis 
and endocarditis. One cannot too strongly em- 
phasise the importance of giving the closest atten- 
tion to all local infections in children. 

The children afflicted with rheumatism, chorea 
or any of the septic contagious diseases likely 
to cause heart disease should be under the 
constant vigil of a careful physician, whose 
instuctions should be followed to the letter. 
These children should have an abundance of 
fresh air and such exercise as Is strictly recom- 
mended. There are oftentimes fatal mistakes 
made In overstepping or ignoring the doctor's 
orders. Children with growing pains or St. 
Vitus' dance should always be watched a Httle 
more carefully than others. For all, the diet 
should be carefully looked after, their bowels 
kept regular, the kidneys active. They should 
be exposed to extremes of temperature as little 
as possible. Their clothing should be warm 
in winter and not too light in summer. Their 
baths should be tepid and regular, to keep the 
skin well and active. Swimming In the open 



SHOULD KNOW AND DO 193 

should be restricted, particularly in fresh-water 
streams and lakes. It is only when the water is 
known to be warm, and when every precaution is 
taken for rescue in case of cramp, that such chil- 
dren should be permitted to swim. If sent to 
school, the teacher should be advised of the child's 
condition, that such a child be not subject to too 
much nervous strain. 

These children, often very bright and alert, 
must be gently but firmly restrained in their tend- 
ency to over-work or over-play. Children often 
present a difficult problem, as they do not under- 
stand the importance of the restriction and forget 
themselves in the interest or excitement of play. 
Then again it is bad to have a child grow up 
thinking too much about itself, fancying it has 
ills with which it is not afflicted. The parents of 
the young woman who has heart trouble should 
have her carefully examined by a physician before 
she promises herself in marriage, to know 
whether the condition of her heart Is such that 
she may be able to perform the duties of a wife; 
whether she may entertain the hope of bearing 
children without risking her life. 

These are questions of vital importance to 
every girl afflicted with heart disease, and should 
be thoroughly understood by the young woman 



194 WHAT HEART PATIENTS 

and by the man whom she would wed before 
an engagement be made. The parents of 
the girl should not deceive themselves in think- 
ing such matters will adjust themselves after 
marriage; on the contrary, they are more apt to 
lead to an early and embarrassing rupture of 
marital relations. On such a serious matter, in- 
volving as it does the whole future life of hus- 
band and wife, the very best medical advice should 
be obtained, that there may be an assurance of the 
physical fitness for connubial happiness or that no 
engagement be made. Cardiac trouble need not 
necessarily debar a woman from marriage, nor 
from bearing children, unless there be an enlarge- 
ment of the heart, although delivery and child- 
nursing are a strain on the heart. 

In the case of a man, the comforts and 
pleasure of a home, the encouragement of a 
helpmate who sympathises, must be weighed 
or balanced against increased cares, added busi- 
ness activity, in the view of his particular 
form of trouble, whether insignificant or serious. 
The young married man should not delay 
choosing a family physician, if possible one who 
will be his friend and a friend of his family. 
The family physician should be one in general 
practice. He it is who knows the children from 



SHOULD KNOW AND DO 195 

their birth, who becomes familiar with all the 
family traits and the personal Idiosyncrasies of 
each member, who cares and sympathises when 
sickness and suffering is In the home, who has an 
affection for the children and rejoices with the 
parents when they are well. Such a family phy- 
sician is an invaluable asset. Should a physical 
crisis come to any member of the family, his aid 
is inestimable to the specialist who is called in 
only in time of crisis, when the patient is most 
distorted from the normal. 

Venereal Diseases. — Syphilis plays such an 
Important part In the cause of heart and blood- 
vessel diseases that I feel It my duty to give here 
another warning cry to the public, that the young 
man may be saved from the terrific dangers caused 
from this unclean disease. Syphilis has many sins 
to answer for, and among the most deadly are the 
degenerative changes it brings about in the walls 
of the arteries. I do not wish to cast any sus- 
picion on thousands of men who are suffering from 
arterial trouble with no indication of venereal dis- 
ease, men who have led clean moral lives, but 
who have inherited a tendency to hardening of 
the arteries or acquired it by strenuous living or 
from other causes. 



196 WHAT HEART PATIENTS 

Gonococcal infection is often an etiological 
factor in heart disease causing destructive endo- 
carditis and not infrequently leading to a serious 
termination. This is one of the most widely 
spread of venereal diseases and its serious and de- 
structive consequences should be known to every 
young man and woman. 

To the parents let me say, " Help your boy 
and girl, not alone by giving them superior moral 
educational and social advantages, but by guarding 
them against ill health. Not only should it be 
a solemn duty to talk to your girl and boy when 
they are approaching the age of puberty, but it 
should be done with the reverence which every 
man and woman should feel is sacred to parent- 
hood, and which will impress the youth with the 
sacred meaning of his manhood and the girl with 
the significance of her womanhood. If you are 
a father, let me pray you to reflect whether your 
father did this for you or whether he did not, 
and how much your own life or health or your 
own mistakes and ill health are due the parent's 
wise commission or thoughtless omission of duty 
in this matter. "... The basis of economic 
life is individual responsibility. It is designed 
that each grown person should feel that the wel- 



SHOULD KNOW AND DO 197 

fare of himself and his family, if he has one, rests 
upon himself. The state enters where his powers 
are insufficient.'^ * 

The boy should know that chastity is not incom- 
patible with good health. Many good boys have 
been led by honest, well-meaning people to believe 
that it is, and have tainted not only their souls but 
their bodies by a dreadful disease, which attacks 
the heart and other organs. 

Age of Prevention. — The health and hope of the 
human race depends in great measure upon the 
physician, and the general public must soon come 
to a realisation of this fact. It is estimated that 
about 80 per cent of all diseases which now afflict 
the human family are preventable. The public has 
been dazzled by the brilliant achievements of our 
modern surgeons, and well they may be, for the 
strides made in many fields of surgery are almost 
beyond belief. In this respect the public has again 
shown its innate love for the spectacular or 
daring, thus stimulating surgeons to great feats 
in operative skill. Operations which were a few 
years ago thought impossible are now daily or 
even hourly successfully performed. Indeed there 
is no vital organ of the human body, even to the 

• Richard T. Ely, " Political Economy." 



198 WHAT HEART PATIENTS 

brain and heart, on which the best surgeons of 
to-day may not operate with success. 

While we are marvelling at the skill, zeal and 
valour of these specially endowed men — for good 
surgeons are born, not made — let us not forget 
that great army of medical men who are quietly 
working in the laboratories, studying the cycle of 
existence of some germ that is destroying thou- 
sands of human lives annually. The age of pre- 
vention is at hand, and the public must recognise 
it. These quiet laboratory workers are the ones on 
whom the public and the practising physicians 
must depend for guidance in the advanced move- 
ment of prevention of disease. If the money now 
spent in the treatment of disease were employed 
in prevention, how much happier would our hu- 
man family be. The misery, sorrow and suffering 
caused by preventable diseases cannot be calcu- 
lated in dollars and cents. The individual is a unit 
of the nation, and when the individual or the in- 
dividual family is healthy, cheerful and contented 
the nation may be said to be fulfilling its function 
to the individual; but when the contrary is true, as 
it is in so many of our American cities, there is 
discontent, strife and sometimes anarchy. It will 
remain a lasting monument to the young state of 
Oklahoma that her Senator, Robert L. Owen, has 



SHOULD KNOW AND DO 199 

done so much to remind his nation of its urgent 
duty in the protection of the people. 

The nation is spending millions annually in pro- 
tecting the farm animals of the country, while 
eighty per cent of the people are dying from pre- 
ventable diseases, a direct disgraceful reproach to 
any intelligent country. Much thought and effort 
has been given in the last ten years to the very wor- 
thy cause of saving the babies, with the result that 
the infant mortality has been diminished very 
materially in the past decade. The chances for 
the child to reach adolescence have very much 
increased in this time, but the chances for reach- 
ing very old age have not increased propor- 
tionately. Indeed, it is said that owing to the 
vicissitudes of our modern life, the chances for 
reaching eighty have reduced in the past two dec- 
ades. 

It has been my object to point out some of 
the errors which oppose longevity, to advise men 
to refrain from forming habits which tend to 
shorten life and make the evening of life's day 
a torture instead of a joy. Men are apt to 
consider the prescription of regular living or the 
modification of habits as a restriction of their per- 
sonal liberty or personal pleasure, and it Is very 
difficult to appeal to their reason on such matters. 



20O WHAT HEART PATIENTS 

For them, "There is scarcely any (folly) 
against which warnings are of less efficacy than 
neglect of health." * Men will take chances of 
wrecking their physical status which they would 
not think of taking with their financial or social 
standing — recognising no law, ignoring human 
reason in dealing with their own bodies, taking 
greater liberties with physical laws than do any 
other species of the animal kingdom. I know of 
no other animal which forms so many pernicious 
habits destructive to life as does man. 

Some heart patients violate every law of health, 
while diligently searching the papers for some 
patent medicine that Is " Guaranteed to cure." 
They are not satisfied when their physician, a man 
whom they do know to be honest, tells them that a 
severe valvular lesion cannot be entirely cured, but 
that by proper living and care much may be done 
in the way of repair. Remedies advertised as 
Infallible cures, much like the plant called " cure- 
all," might be more properly called " cure-noth- 
ing," having no place In rational treatment. In 
this enlightened day it is often a real surprise to 
find an otherwise ihtelligent person displaying the 
most child-like faith in a quack, who advertises 
** Cure guaranteed or money refunded." I regret 
* Rambler y No. 48. 



SHOULD KNOW AND DO 201 

to say, some of these advertisers have medical 
diplomas, and should have a higher sense of their 
position In life than taking advantage of the 
credulity of their suffering fellow-men. 

The man who holds out false hopes of curing a 
heart patient by some secret, short, magical 
method is worse than a thief, for he not only robs 
such a patient of his money, but what Is Infinitely 
worse, robs him of his chance of being benefited 
by proper rational treatment and steals from him 
often the last chance of getting relief. As a gen- 
eral rule, the patient should: Beware of the phy- 
sician who guarantees cures. Beware of the one 
who has some special form of treatment, which 
he doesn't reveal to other physicians. Beware of 
the one who diagnoses the case by letter. Beware 
of the one who has something to sell, for whose 
*' dollar bottle " or whose high-sounding apparatus 
are bartered precious chances of restoration to 
health. 

Physical examinations of the well from time 
to time should be much more common. Some 
persons shun advice, fancying themselves secure 
from disease as long as they are kept in ignorance 
of its existence. They remind one of a chicken, 
v/hich, when pursued, hides Its head under a log 
or stone and closes Its eyes, feeling itself safe 



202 WHAT HEART PATIENTS 

from danger. When mental or bodily activity Is 
followed by unusual fatigue or exhaustion there 
Is sign for investigation. 

Only those persons who read the medical jour- 
nals and the recent medical publications can have 
any conception of the tremendous effort being 
made by the great bodies of medical men the world 
over in the prevention of disease. Instead of 
paying out sums to further their profession pe- 
cuniarily, to increase their practice, they are giv- 
ing out enormous sums to prevent disease and to 
decrease the number of patients. The Medical 
Association of America spent last year forty 
thousand dollars in this great cause. Further, 
there is a written or unwritten law in every med- 
ical society of any importance, denying the right 
of any member to withhold from his profession 
any discoveries which may alleviate suffering or 
prolong life. The physician has no patent-right 
to a remedy. If he have a patent it Is apt to be 
regarded by the medical profession as a patent- 
wrong, with direct or Indirect homicidal con- 
sequences. 

There never has been a time In the history of 
medicine when physicians were in such position to 
know the condition of the heart as they are to-day. 
The modern scientific instruments of precision, the 



SHOULD KNOW AND DO 203 

sphygmograph, polygraph, sphygmotonograph, 
orthodiograph, electrocardiograph and others 
not necessary to mention, have given an under- 
standing of the heart functions entirely unknown 
a few years ago. With these instruments we are 
able to measure the exact amount of resistance 
the heart is pumping against, we are able to 
detect the slightest irregularity in the pulse beat, 
we are able to measure the pulse wave; we are 
able to observe the slightest enlargement; we are 
able to detect the slightest weakness in the heart 
muscle; we are able to measure with a fair degree 
of accuracy the amount of reserve force in the 
heart muscle; in other words, we can get a fairly 
accurate estimate of the amount of work a heart 
is capable of doing. We are further enabled by 
these instruments to study much more accurately 
the mechanism by which symptoms are produced 
and to interpret their prognostic significance. It 
will be readily seen that these studies and inter- 
pretations are invaluable in guiding us in our 
treatment of heart trouble. In setting forth the 
advantages of the modern instruments of precision 
as an aid in diagnosis, it is not my intention to 
undervalue the interpretations of the cultivated 
finger and experienced sense of the practitioner, 
which no instruments will ever dispense with, but 



204 WHAT PATIENTS SHOULD DO 

which, when supplemented or verified by the in- 
struments, conduce to accuracy and better com- 
prehension of heart diseases. 

" When the history of the present era is writ- 
ten, the most important facts to be recorded will 
not be tho§e connected with politics or interna- 
tional relations. The historian of the future will 
regard as the most important event of the present 
period the acquisition, beginning about 1870, by 
civilised man of the knowledge and control of 
preventable diseases." * 

* The Journal of the American Medical Association^ 
Editorial, July 20, 1912. 



THE END 



MAY 19 1913 



